Ischemic stroke and n-3 fatty acids

The content of fatty acids in subcutaneous adipose tissue was measured to determine whether differences of fatty acids correlate with presence or absence of cerebral infarction in individual patients. Adipose tissue microbiopsies was sampled from 10 patients with computed tomography (CT) verified cerebral infarction and 10 matched control subjects, and assayed for content of fatty acids by gas-liquid chromatographic analysis. There were no differences in levels of n-3 fatty acids of marine origin. Patients with cerebral infarction had statistically significant lower levels of the essential fatty acids linoleic acid (mean+/-SE, 8.9+/-0.4 v 10.7+/-0.5%) (P<.05) and linolenic acid (0.80+/-0.05 v 1.00+/-0.06%) (P<.05) and high levels of palmitoleic acid (8.5+/-0.6% v 5.7+/-0.4%) (P<.005) indicative of increased lipid synthesis de novo, which might explain the depressed levels of fatty acids primarily supplied by the diet. Although significant differences in levels of essential fatty acids were found, no judgment could be made regarding a causal relationship between essential fatty acids and cerebral infarction. The present study does not support the hypothesis of an association between dietary fatty acids (e.g., fish consumption) and ischemic stroke.     

Ischemic stroke subtypes: risk factors, functional outcome and recurrence

The etiology of ischemic stroke affects its prognosis, outcome and management. Our aims were to determine risk factors, clinical and imaging variables and prognostic differences in acute ischemic stroke subtypes. In this study, we prospectively investigated 264 consecutive patients with acute ischemic stroke between 1996 and 2000. All of the patients were categorized to one of four major ischemic stroke subtype based on TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria. The mean age was greater in patients with stroke of undetermined etiology (SUE). Prevalence of hypertension was higher in patients with lacunar infarct (LAC) than other subtypes. Smoking was less frequent in patients with cardioembolism (CARD). The mean infarct size was largest in patients with large artery atherosclerosis (LAA) while there were no differences in location or conversion of the infarct into hemorrhage. The proportion of the patients with milder neurological deficits at entry was higher in patients with LAC subtype. The rate of independent patients were different between subtypes: 62% in LAC, 43% in CARD, 38% in SUE, 35% in LAA at discharge (p=0.01), and 91% in LAC, 69% in CARD, 59% in SUE, 60% in LAA at 6 months (p<0.001). Recurrence rates were not different between groups. We conclude that risk factors, clinical imaging variables are different among ischemic stroke subtypes and that neurological status on admission and during follow-up strongly favors LAC. Received: 20 June 2001 / Accepted in revised form: 30 October 2001     

Ischemic stroke mimics: A comprehensive review

BackgroundIschemic stroke is the leading cause of disability and one of the leading causes of death. Ischemic stroke mimics (SMs) can account for a noteble number of diagnosed acute strokes and even can be thrombolyzed.MethodsThe aim of our comprehensive review was to summarize the findings of different studies focusing on the prevalence, type, risk factors, presenting symptoms, and outcome of SMs in stroke/thrombolysis situations.ResultsOverall, 61 studies were selected with 62.664 participants. Ischemic stroke mimic rate was 24.8% (15044/60703). Most common types included peripheral vestibular dysfunction in 23.2%, toxic/metabolic in 13.2%, seizure in 13%, functional disorder in 9.7% and migraine in 7.76%. Ischemic stroke mimic have less vascular risk factors, younger age, female predominance, lower (nearly normal) blood pressure, no or less severe symptoms compared to ischemic stroke patients (p < 0.05 in all cases). 61.7% of ischemic stroke patients were thrombolysed vs. 26.3% among SMs (p < 0.001). (p < 0.001). Overall intracranial hemorrhage was reported in 9.4% of stroke vs. 0.7% in SM patients (p < 0.001). Death occurred in 11.3% of stroke vs 1.9% of SM patients (p < 0.001). Excellent outcome was (mRS 0–1) was reported in 41.8% ischemic stroke patients vs. 68.9% SMs (p < 0.001). Apart from HINTS manouvre or Hoover sign there is no specific method in the identification of mimics. MRI DWI or perfusion imaging have a role in the setup of differential diagnosis, but merit further investigation.ConclusionOur article is among the first complex reviews focusing on ischemic stroke mimics. Although it underscores the safety of thrombolysis in this situation, but also draws attention to the need of patient evaluation by physicians experienced in the diagnosis of both ischemic stroke and SMs, especially in vertigo, headache, seizure and conversional disorders.     

Ischemic stroke in a child mistaken as functional disorder

Stroke is a rare but increasingly recognized disorder in children. Lack of published clinical trials and experience in most institutions has resulted in significant challenges for clinicians who manage children with stroke. We report a case of 16-year-old male child who was presented with history of sudden onset of weakness 2 months back and before he could consult the physician, the weakness improved significantly and a misdiagnosis of functional disorder was made at a peripheral hospital. Children with stroke may have subtle manifestations and to make an early diagnosis of stroke in children there is need of awareness about this entity in children.     

Treating anxiety after stroke using cognitive-behaviour therapy: Two cases

Anxiety disorders are common after stroke. However, information on how to treat them with psychotherapy in this population is highly limited. Modified cognitive-behaviour therapy (CBT) has the potential to assist. Two cases of individuals treated with modified CBT for anxiety after stroke are presented. The modification was required in light of deficits in executive and memory function in one individual and in the context of communication difficulties in the other. The anxiety symptoms were treated over seven and nine sessions, respectively. Both participants improved following the intervention, and these improvements were maintained at 3 month follow-ups. Further case-series and randomised controlled designs are required to support and develop modified CBT for those with anxiety after stroke.     

脑卒中后觉醒障碍

脑卒中后觉醒障碍系指脑卒中引起的中枢神经系统损害所致睡眠-觉醒障碍,临床上分为3种类型,即脑卒中后睡眠过多、白天过度嗜睡、疲劳感.由于其患病率仅次于睡眠呼吸紊乱,并影响脑卒中患者的康复和生活质量,早期干预有可能改变患者不良转归,近年来逐渐成为脑卒中治疗和康复的新靶点.     

缺血性脑卒中诱导的免疫抑制综合征与副交感神经系统的相关性

卒中后感染是卒中患者最常见的并发症之一,其高发的原因是中枢神经系统损伤诱导的免疫抑制综合征。本综述阐述了两个独立的现象。（1）在脑梗死细胞水肿高峰期,及脑梗死数周后存在免疫抑制,可能与交感与副交感神经同时受抑制、副交感神经系统相对增强有关;（2）副交感神经活化对非特异性免疫具有明显的抑制作用,因而可以抑制特异性免疫。据此我们推测脑梗死后高发的感染率及免疫反应受损,至少在某种程度上与迷走神经活性的增加及继发的免疫抑制相关。     

双侧电刺激对脑卒中后康复的影响

目的探讨双侧电刺激治疗对脑卒中后神经功能康复的影响。方法150例急性脑卒中偏瘫患者随机分为两组。两组均采用常规药物和功能锻炼治疗,双侧治疗组加用双侧电刺激治疗,对照组加用单侧电刺激治疗。疗程1个月。采用临床神经功能缺损程度评分、简式Fugl-meyer运动功能评分（FMA）、改良Barthel指数（MBI）,于初期（治疗前）、末期（治疗后3个月）对两组患者进行评定神经功能。结果治疗后,双侧治疗组临床神经功能缺损程度评分明显减少（P〈0．01）;FMA、MBI明显提高（P〈0．01）。结论双侧电刺激治疗可明显促进患肢运动功能康复,降低致残率,提高日常生活能力。     

脑卒中后痴呆的相关因素分析

目的 探讨脑卒中后产生痴呆的发生率及其相关因素.方法 对278例卒中患者入院时进行神经功能缺损程度评分和智能评估,病程3个月后,再进行智能评估.结果 脑卒中后痴呆的发生率为30.6％,它与发病次数,年龄、文化程度、脑卒中的部位、病灶数目和神经功能缺损以及血糖密切相关.与性别、吸烟、饮酒、血压、卒中性质关系不大(P＞0.05).结论 应重视脑卒中后痴呆的发生,它的发病是多因素综合作用的结果.     

Ischemic lesion water homeostasis after thrombectomy for large vessel occlusion stroke within the anterior circulation: The impact of age

The effect of age on lesion pathophysiology in the context of thrombectomy has been poorly investigated. We aimed to investigate the impact of age on ischemic lesion water homeostasis measured with net water uptake (NWU) within a multicenter cohort of patients receiving thrombectomy for anterior circulation large vessel occlusion (LVO) stroke. Lesion-NWU was quantified in multimodal CT on admission and 24 h for calculating Δ-NWU as their difference. The impact of age and procedural parameters on Δ-NWU was analyzed. Multivariable regression analysis was performed to identify significant predictors for Δ-NWU. Two hundred and four patients with anterior circulation stroke were included in the retrospective analysis. Comparison of younger and elderly patients showed no significant differences in NWU on admission but significantly higher Δ-NWU (p = 0.005) on follow-up CT in younger patients. In multivariable regression analysis, higher age was independently associated with lowered Δ-NWU (95% confidence interval: −0.59 to −0.16, p < 0.001). Although successful recanalization (TICI ≥ 2b) significantly reduced Δ-NWU progression by 6.4% (p < 0.001), younger age was still independently associated with higher Δ-NWU (p < 0.001). Younger age is significantly associated with increased brain edema formation after thrombectomy for LVO stroke. Younger patients might be particularly receptive targets for future adjuvant neuroprotective drugs that influence ischemic edema formation.     

Ischemic stroke selectively inhibits REM sleep of rats

Sleep disorders are important risk factors for stroke; conversely, stroke patients suffer from sleep disturbances including disruptions of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep and a decrease in total sleep. This study was performed to characterize the effect of stroke on sleep architecture of rats using continuous electroencephalography (EEG) and activity monitoring. Rats were implanted with transmitters which enabled continuous real time recording of EEG, electromyography (EMG), and locomotor activity. Baseline recordings were performed prior to induction of either transient middle cerebral artery (MCA) occlusion or sham surgery. Sleep recordings were obtained for 60 h after surgery to identify periods of wakefulness, NREM, and REM sleep before and after stroke. Spectral analysis was performed to assess the effects of stroke on state-dependent EEG. Finally, we quantified the time in wake, NREM, and REM sleep before and after stroke. Delta power, a measure of NREM sleep depth, was increased the day following stroke. At the same time, there was a significant shift in theta rhythms to a lower frequency during REM and wake periods. The awake EEG slowed after stroke over both hemispheres. The EEG of the ischemic hemisphere demonstrated diminished theta power specific to REM in excess of the slowing seen over the contralateral hemisphere. In contrast to rats exposed to sham surgery which had slightly increased total sleep, rats undergoing stroke experienced decreased total sleep. The decrease in total sleep after stroke was the result of dramatic reduction in the amount of REM sleep after ischemia. The suppression of REM after stroke was due to a decrease in the number of REM bouts; the length of the average REM bout did not change. We conclude that after stroke in this experimental model, REM sleep of rats is specifically and profoundly suppressed. Further experiments using this experimental model should be performed to investigate the mechanisms and consequences of REM suppression after stroke.     

Ischemic stroke caused by giant cell arteritis associated with pulmonary adenocarcinoma

Giant cell arteritis (GCA) is the most common vasculitis in patients older than 50 years, and it is occasionally a cause of ischemic stroke. GCA as a paraneoplastic manifestation has been rarely described. We describe a 77-year-old man with a sudden onset of dizziness, vomiting, and gait disturbances. Following imaging studies, a diagnosis of bulbar ischemic stroke with left vertebral artery stenosis was made. Based on a history of polymyalgia rheumatica, on laboratory tests, and brain digital subtraction angiography, a diagnosis of GCA was advanced and the patient underwent high-dose steroidal therapy. After a total body 18-FGD PET imaging, a pulmonary adenocarcinoma was found.Vertebral artery involvement is a rare but important occurrence in GCA as it carries a high mortality rate, and may require a vigorous therapeutic approach. The association of lung cancer and GCA is infrequent, and the relationship between malignancy and GCA remains unclear. Whereas the search for a malignancy in the setting of a GCA is not routinely performed, the use of total body PET when a large vessel vasculitis is suspected may provide useful information on disease and help recognize occult neoplasms.     

脑卒中后基底节性失语的特点

目的探讨脑卒中后基底核性失语的特点。方法选择急性期单侧皮层下脑卒中后基底核性失语患者29例,行失语症检查,分析其语言学特征。结果基底节性失语有较重的听理解障碍及书写能力的受损,其中理解中度障碍18例(62%);重度障碍11例(38%);书写障碍以描写障碍突出,重度障碍25例(86%);复述相对较好,轻中度障碍24例(83%)。23例(79%)出现语音障碍,包括音韵及音律障碍。8例患者出现言语失用。基底神经节性失语多为轻至中度语言表达障碍,表现为语言减少,口语流畅性差,说话缓慢、费力,启动难,词与词之间缺乏连惯性,词汇单调,理解障碍相对较轻,可有找词困难(说不出恰当词),偶有错语,但复述正常或相对正常。结论基底节性失语在脑卒中后较为常见,其类型复杂,几乎包括所有失语类型,表现为较重的听理解障碍及书写能力的受损,书写障碍以描写障碍突出;复述相对较好;多数患者出现语音障碍,口语流畅性差;言语失用常见;命名障碍较常见。     

Prediction of sleep-disordered breathing after stroke

Objective/backgroundSleep-disordered breathing (SDB) is highly prevalent after stroke and is associated with poor outcomes. Currently, after stroke, objective testing must be used to differentiate patients with and without SDB. Within a large, population-based study, we evaluated the usefulness of a flexible statistical model based on baseline characteristics to predict post-stroke SDB.Patients/methodsWithin a population-based study, participants (2010–2018) underwent SDB screening, shortly after ischemic stroke, with a home sleep apnea test. The respiratory event index (REI) was calculated as the number of apneas and hypopneas per hour of recording; values ≥10 defined SDB. The distributed random forest classifier (a machine learning technique) was applied to predict SDB with the following as predictors: demographics, stroke risk factors, stroke severity (NIHSS), neck and waist circumference, palate position, and pre-stroke symptoms of snoring, apneas, and sleepiness.ResultsWithin the total sample (n = 1330), median age was 65 years; 47% were women; 32% non-Hispanic white, 62% Mexican American, and 6% African American. SDB was found in 891 (67%). The area under the receiver operating characteristic curve, a measure of predictive ability, applied to the validation sample was 0.75 for the random forest model. Random forest correctly classified 72.5% of validation samples.ConclusionsIn this large, ethnically diverse, population-based sample of ischemic stroke patients, prediction models based on baseline characteristics and clinical measures showed fair rather than clinically reliable performance, even with use of advanced machine learning techniques. Results suggest that objective tests are still needed to differentiate ischemic stroke patients with and without SDB.     

脑卒中后睡眠障碍相关因素分析

目的 探讨脑卒中患者睡眠障碍的临床情况及相关影响因素.方法 选取山东省东营市胜利油田中心医院神经内科自2005年1月至2010年6月收治的脑卒中患者204例,以匹兹堡睡眠质量指数量表(PSQI)判定是否睡眠障碍,比较不同性别、年龄、脑卒中部位患者的睡眠障碍发生率.通过症状自评量表(SCL-90)比较睡眠障碍和无睡眠障碍患者的身心健康状况,通过汉密尔顿抑郁量表(HAMD)、Barthel指数和美国国立卫生研究院卒中量表(NIHSS)评分比较睡眠障碍和无睡眠障碍患者抑郁、生活能力及神经功能缺损程度的差异.结果 本组患者睡眠障碍95例,发生率为46.6%(95/204).女性患者睡眠障碍发生率较高,差异有统计学意义(P＜0.05).≥70岁患者睡眠障碍发生率最高(57.6%),其次为＜50岁(41.5%)、50～69岁人群(32.9%),脑卒中发生在皮质下患者的睡眠障碍发生率最高(64.2%),其次为大脑皮质(27.4%)、小脑(4.5%),差异均有统计学意义(P＜0.05).卒中部位位于左半球患者睡眠障碍发生率明显高于右半球患者,差异有统计学意义(P＜0.05);与脑卒中后无睡眠障碍患者比较,脑卒中后睡眠障碍患者SCL-90 9项指标、HAMD评分及NIHSS评分均较高,而Barthel指数较低,差异均有统计学意义(P＜0.05).结论 脑卒中患者睡眠障碍发生率较高,并与性别、年龄、卒中部位有关,可导致抑郁、焦虑、神经功能缺损,生活质量下降,临床治疗过程中应积极做好护理工作.

Abstract：

Objective To explore the clinical features of sleep disorder in patients with stroke and its related factors. Methods Two hundred and four patients with stroke, admitted to our hospital from January 2005 to June 2010, were chosen; Pittsburgh Sleep Quality Index (PSQI) was employed to determine whether these patients had sleep disorder; the prevalences of sleep disorder in patients with different ages, genders and lesions of stroke were compared. Symptom Checklist-90 (SCL-90)questionnaire was used to compare the physical and mental conditions of patients with or without sleep disorder; Hamilton Depression Rating Scales (HAMD), Barthel index, and National Institutes of Health Stroke Scale (NIHSS) were employed to compare the differences of depression, viability and neurologic impairment in patients with or without sleep disorder. Results The prevalence of sleep disorder was 46.6% (95/204), and it was higher in female group (53.8% vs 38.8%; x2=3.851, P=0.033). Patients aged ≥70 years had the highest rate of sleep disorder (57.6%), followed by patients aged ＜50 years (41.5%),and then patients aged between 50 and 69 years showed the lowest rate (32.9%). The sites of stroke located in the subcortex, cortex, and cerebellum enjoyed their prevalences of 64.2%, 27.4% and 4.5%,respectively. The incidence of sleep disorder in patients with stroke located in the left hemisphere was obviously higher than that in the right hemisphere (x2=7.688, P=0.008). The results of 9 indexes of SCL-90, scores of HAMD and NIHSS in patients with sleep disorder were significantly higher than those in patients without sleep disorder, while the Barthel index was in the opposite position with obvious differences (P＜0.05). Conclusion High prevalence of sleep disorder in patients with stroke is noted,which is related to gender, age of the patients and the sites of stroke, and may lead to depression, anxiety,neurological functional deficit and decrease of life quality. And we should pay more attention to nursing care during all the treatment.     

影响急性脑卒中后吞咽障碍预后的因素

目的 探讨影响脑卒中后吞咽障碍(dysphagia after stroke,DAS)预后的因素,为优化DAS的管理提供指导.方法 选择经标准吞咽评估(Standardized Swallowing Assessments,SSA)确诊的196例DAS患者,详细记录入院时的年龄、性别、是否有糖尿病史、高血压痛史、卒中史、是否为脑干卒中、卒中病灶大小、卒中病灶是否多发、巴塞指数( Barthel index,BI)、NIH卒中量表(NIH Stroke Scale,NIHSS)评分、血糖、高敏C反应蛋白(high-sensitivity C- reactive protein,CRP)、血浆纤维蛋白原浓度(blood plasma fibrinogen density,Fib)、低密度脂蛋白(low - density lipoprotein,LDL).6个月 后,按洼田饮水试验量表评定标准将患者分为预后良好与预后不良两组.以上述因素为自变量,以预后是否良好为因变量进行多因素分析.结果 年龄≥70岁、BI≤30、LDL≥3 mg/ L与DAS预后密切相关,差异具有统计学意义(P＜0.05).结论 DAS患者入院时的临床资料可以协助判断吞咽障碍的预后.年龄≥70岁、BI≤30、LDL≥3 mg/L,是DAS患者吞咽功能预后不良的独立危险因素.     

卒中后失语的临床研究现状

脑血管疾病或者脑外伤等脑损伤会引起多种高级神经功能障碍,常见的症状是语言障碍——失语症。随着社会现代化的发展、生活质量的提高,患者愈后的生活质量、语言功能的保存逐渐成为医患关注的焦点。本文综合介绍了目前临床工作中关于卒中后失语常用的评价方法、治疗手段、康复措施及沟通技巧。并展望了失语症可能的研究方向。     

脑卒中后癫痫50例临床研究

目的探讨脑卒中后癫痫的临床特点，癫痫对脑卒中恢复期神经功能康复的影响。方法50例脑卒中后继发癫痫患者进行发作部位、类型、治疗时间及效果等分析，并按病情轻、中、重三组进行功能康复评分。结果脑卒中后癫痫发生率5．1%（50／980），其中早发癫痫72％（36／50），迟发癫痫28％（14／50）。皮层病灶继发癫痫72％（36／50），皮层下病灶继发癫痫占28％（14／50）。早发癫痫中全身发作27例．部分性发作9例，迟发癫痫中全身发作4例，部分性发作10例。癫痫组神经功能缺损评分均差于对照绀组（P〈0．05），结论脑卒中后癫痫皮层病灶多见，早发癫痫以全身发作为主，迟发癫痫以部分发作为主。脑卒中合并癫痫患者的治疗效果差于对照组，抗癫痫治疗有利于神经功能康复。