动脉内溶栓治疗急性缺血性脑卒中的临床分析

目的:探讨使用动脉内溶栓方法治疗急性缺血性脑卒中的效果。方法:回顾138例急性缺血性脑卒中患者,发病距接受治疗的时间为3～24h,采取超选择性动脉溶栓。结果:颈内动脉闭塞22例,大脑中动脉主干闭塞38例,大脑中动脉分支闭塞33例,大脑前动脉闭塞1例,椎基底动脉系统血管闭塞12支。脑血管造影未见异常32例。闭塞血管再通者,颈内动脉12例;大脑中动脉24例;大脑中动脉分支21例;椎基底动脉8例。8例患者因明显血管狭窄,治疗后予以球囊扩张,支架植入术。临床症状完全恢复或明显好转83例,溶栓后脑出血患者5例。结论:超选择动脉内溶栓是治疗急性缺血性脑卒中的有效方法。     

糖尿病与进展性缺血性脑卒中相关性研究

目的 探讨糖尿病与进展性缺血性脑卒中的相关性.方法 我院神经内科2006-05～2009-05收治的缺血性脑卒中患者130例为研究对象,其中伴糖尿病患者64例为糖尿病组,非糖尿病患者66例为非糖尿病组,比较2组发展为进展性缺血性脑卒中的差异.结果 糖尿病组64例中诊断为进展性卒中41例,占64.1%;非糖尿病组66例诊...     

DWI在急性缺血性脑卒中的临床应用

目的:观察并评价急性缺血性脑卒中MRI弥散加权成像(DWI)作用以及其对临床进展、预后的预测。方法:对62例确诊为脑梗死的患者在不同时间行颅脑CT、常规MRI和DWI扫描后,进行影像学(包括48h内CT和DWI)的图像特征分析及ASPECT评分。患者均采用统一的治疗方案,进行病人信息、血管危险因素分析,初始和48h临床卒中症状NIHSS评分,以及改良Rankin评分。结果:病灶在发病后3天,尤其12h内在DWI上显示均质高信号,而CT、常规MRI多未能显示,在发病后8～20天内呈混杂高信号,大约在3w后高信号消失。24hDWI的ASPECT评分为预测进展性脑梗死独立因素(P<0.05)。进展性脑梗死患者改良Rankin评分较差(P<0.05)。结论:DWI诊断超早期脑梗死比CT、常规MRI有明显优势。24hDWI的ASPECT评分较高多预示进展性脑梗死的发生及较差的临床预后。     

Hurdles in stroke thrombolysis: Experience from 100 consecutive ischemic stroke patients

Background:

Acute management of ischemic stroke involves thrombolysis within 4.5 h. For a successful outcome, early recognition of stroke, transportation to the hospital emergency department immediately after stroke, timely imaging, proper diagnosis, and thrombolysis within 4.5 h is of paramount importance.

Aim:

To analyze the obstacles for thrombolysis in acute stroke patients.

Materials and Methods:

The study was conducted in a tertiary care center in South India. A total of hundred consecutive patients of acute ischemic stroke who were not thrombolysed, but otherwise fulfilled the criteria for thrombolysis were evaluated prospectively for various factors that prevented thrombolysis. The constraints to thrombolysis were categorized into: i) Failure of patient to recognize stroke symptoms, ii) patient''s awareness of thrombolysis as a treatment modality for stroke, iii) failure of patient''s relative to recognize stroke, iv) failure of primary care physician to recognize stroke, v) transport delays, vi) lack of neuroimaging and thrombolysis facility, and vii) nonaffordability.

Results:

The biggest hurdle for early hospital presentation is failure of patients to recognize stroke (73%), followed by lack of neuroimaging facility (58%), nonaffordability (56%), failure of patient''s relative to recognize stroke (38%), failure of the primary care physician to recognize stroke (21%), and transport problems (13%). Awareness of thrombolysis as a treatment modality for stroke was seen only in 2%.

Conclusion:

Considering the urgency of therapeutic measures in acute stroke, there is necessity and room for improvement to overcome various hurdles that prevent thrombolysis.     

Elevated bilirubin after acute ischemic stroke linked to the stroke severity

Background

Our previous study demonstrated that the level of serum bilirubin after acute ischemic stroke (AIS) was correlated to the severity of stroke, also there has the evidence of hyperbilirubinemia prevalent in AIS. We aimed to identify the exact change of bilirubin in the early phase of AIS, and study if this kind of change linked to the severity of stroke.

Methods

Bilirubin and other biochemical indexes were measured in 608 AIS patients and 188 transient ischemic attack (TIA) patients which set as the control group. National Institutes of Health Stroke Scale (NIHSS) scores were assessed simultaneously with blood collection. First, the level of bilirubin and its distribution were compared between the AIS and control group. According to a cut-off point, we next analyzed the impacted factors of elevated bilirubin including the direct bilirubin (Dbil) and total bilirubin (Tbil), especially the correlation between elevated bilirubin and the severity of stroke. Finally, we compared the difference of concentration and percent of elevated bilirubin among the Oxford Community Stroke Project (OCSP) subtypes.

Results

The level of serum Dbil and Tbil was significantly higher in the AIS group than that in the TIA group. Different distribution was observed between the two groups, which manifested as the percent of low bilirubin level group was lower while high level group was higher in AIS than that in TIA, the p value were 0.043 and 0.078 in Dbil and Tbil, respectively. When the cut-off point of elevated bilirubin was selected as Dbil ≥ 6.84 μmol/L and Tbil ≥ 22.2 μmol/L, we found that both NIHSS score and relative severity of AIS were significantly associated with elevated bilirubin whenever in Dbil or Tbil, so did the OCSP subtypes. This trend was still maintained by multivariable logistic regression analysis adjust for relative influence factors. In regard of OCSP subtypes, the highest level of bilirubin was found in TACI, so did the highest rate of elevated bilirubin.

Conclusion

The serum levels of Dbil and Tbil were increased after AIS, which linked to the severity of stroke.     

复发性与初发性脑梗死患者胰岛素抵抗的比较

目的 研究复发性与初发性脑梗死患者的胰岛素抵抗(IR)情况.方法 对42例复发性脑梗死、40例初发性脑梗死和30例对照组进行研究.测定并比较三组人群的体重指数(BMI)、平均动脉压(MAP)、糖化血红蛋白(HbAlC)、胰岛素抵抗指数(HOMA-IR)、胰岛素敏感指数(ISI)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、颈动脉内膜-中层厚度(CIMT)等指标.结果 对照、初发卒中及复发卒中三组人群的HOMA-IR、ISI和CIMT存在显著的组间差异(P<0.05).脑梗死患者的ISI与TG、LDL-C、BMI、CIMT以及MAP呈负相关,与HDL-C呈正相关.结论 IR与脑梗死复发的关系需要进一步研究证实.     

Antiplatelet strategy for acute ischemic stroke: A mini review

Transient ischemic attacks and minor ischemic strokes have a high risk of an unstable clinical course in the initial 48-72 h after symptom onset. Early antiplatelet treatment is recommended to treat most patients with acute ischemic stroke because few patients can be treated with thrombolysis due to the limit of strict indications, such as a time window. Antiplatelets aim to prevent recurrence or deterioration of stroke. The guidelines recommend the use of aspirin in the acute stage based on two clinical trials. However, some patients still developed recurrence or deterioration of stroke despite timely aspirin administration. Thus, the question remains unclear whether another effective and safe antiplatelet strategy for the treatment of acute ischemic stroke exists. Growing evidence shows that combination antiplatelets may be superior to mono antiplatelets in the treatment of acute ischemic stroke.     

移动卒中单元在院前救治急性缺血性脑卒中的应用

急性缺血性脑卒中是严重威胁人类健康的疾病,时间窗内的治疗对该病至关重要。传统模式往往由于院前时间的延误以及入院后头颅CT检查时间的延误,使患者错过了最佳的治疗时间。移动卒中单元的出现使救治时间大大缩短,患者在配备头颅CT的急救车上即可进行诊治,为院内的下一步治疗节约了时间,提高了急性脑卒中患者的救治率,降低了致残率。     

Predictors of outcome after acute ischemic stroke

The aim of this study was to determine which variables should be the predictors for clinical outcome at discharge and sixth month after acute ischemic stroke. METHODS: Two hundred and sixty-six consecutive patients, each with an acute ischemic cerebrovascular disease, were evaluated within 24 h of symptom onset. We divided our patients into two groups; 1 - Independent (Rankin scale RS < or = 2) and, 2 - Dependent (RS>3) and death. Baseline characteristics, clinical variables, risk factors, infarct subtypes and radiologic parameters were analyzed. RESULTS: Canadian Neurological Scale (CNS) on admission <6.5 [odds ratio (OR) 22] and posterior circulation infarction (OR 4.2) were associated with a poor outcome at discharge from hospital whereas only a CNS score <6.5 (OR 14) was associated with a poor outcome at 6 months. CONCLUSIONS: Severity of neurologic deficit is the most important indicator for clinical outcome in acute ischemic stroke both at short-term and at sixth month, whereas posterior circulation infarction also predicts a poor outcome at discharge.     

Seizures in childhood ischemic stroke in Taiwan

In this retrospective study, we collected clinical and radiographic data on children (age range, 1 month to 18 years) with symptoms and radiographic confirmation of seizure after ischemic stroke for the period of January 1996 to July 2006. Thirty-nine out of 94 children with ischemic stroke had poststroke seizures. Thirty-three out of 39 children with poststroke seizures had new onset seizures but only data of 28 were available. Infection was the most common etiology in the early poststroke seizure group (52.4%) but not in the late poststroke seizure group (0%). Infarction involving arterial ischemic stroke of anterior circulation were the most common in both the early poststroke seizure (61.9%) and the late poststroke seizure group (57.1%). Epilepsy was the most common sequelae in both the early poststroke seizure (38.1%) and late poststroke seizure group (100%). Children who had initial focal neurological sign (100% vs. 38.1%; P=0.007) or the focal cortical dysfunction on EEG (85.7% vs. 33.3%; P=0.029) were prone to develop late poststroke seizures. Late poststroke seizures had a high risk of developing poststroke epilepsy (100% vs. 38.1%; P=0.007). We conclude that seizures commonly occur in childhood ischemic stroke. Most poststroke seizures developed at an early stage. Infection was the most common etiology that caused early poststroke seizures in childhood ischemic stroke. Initial focal neurological signs and focal cortical dysfunction on EEG are risk factors for developing epilepsy. Poststroke seizures did not affect mortality, but there was a significant difference in normal outcome and epilepsy between those with or without poststroke seizures.     

Long-term prognosis of ischemic stroke in young adults

Abstract Background There have been few studies of the long-term prognosis of young adults with ischemic stroke. The present study aimed to evaluate the long-term clinical outcome in a large series of young adults with ischemic stroke admitted to a tertiary medical center over the last 27 years, and to identify possible predictors for mortality, stroke recurrence and poor functional recovery. Methods We retrospectively reviewed 272 young adults (15–45 years) with a first-ever ischemic stroke admitted to the Neurology Department of University Hospital 12 de Octubre between 1974 and 2001. Follow-up assessments were performed by review of medical records and telephone interviews. Results Nine patients (3 %) died as the result of their initial stroke and follow-up information about the status of 23 (8%) patients was not available. The remaining 240 patients (89%) were followed. Two hundred and ten of them (88%) were alive with a mean follow-up of 12.3 years and 30 (12%) died during follow-up. The average annual mortality rate was 1.4%, being notably higher during the first (4.9%) than in the subsequent years (0.9 %) after the initial stroke. Ninety per cent of the followed patients were independent and 53% returned to work, although adjustments were necessary for 23% of them. The annual stroke recurrence rate during the first year was 3.6% dropping to 1.7 % in subsequent years. Age over 35 years, male gender, the presence of cardiovascular risk factors and large-artery atherosclerosis in the carotid territory were predictors of negative long-term outcome after the initial stroke. Conclusions The long-term prognosis for the ischemic stroke in the young is better than in the elderly, but the risk of mortality in young adults with ischemic stroke is much higher than in the general population of the same age. A bad prognosis is associated with an atherosclerotic risk profile, with a higher mortality and recurrent stroke rates and poorer functional recovery. The main functional limitation in the young survivors of their initial ischemic stroke occurs in work activity, since most patients are independent but almost half of them do not return to work.     

颈动脉狭窄在急性缺血性脑卒中的作用

目的：探讨颈动脉狭窄在缺血性脑卒中所起的作用。方法：依据临床和ＣＴ诊断标准，将４８例信院病人分为腔隙性脑梗死组（２７例）和非腔隙性脑梗死组（２１例）。两组病人均不含椎基底动脉系统和心源性栓塞所致的颈内动脉系统脑梗死及行两则颈部血管彩色多谱勒超声显像仪检测。结果：两组间脉压差和甘油三酯水平有显著差异（分别Ｐ〈０．００１，Ｐ〈０．０５）；腔隙性脑梗死组病灶同侧的颈动脉狭窄（≥５０％）发生率为１８．５％     

急性缺血性脑卒中CISS分型与危险因素相关性分析

目的探讨急性缺血性卒中中国缺血性卒中亚型（CISS）分型与不同危险因素的关系。方法回顾性分析连续登记的急性缺血性脑梗死患者,记录其危险因素,并按CISS分型标准将急性缺血性卒中分为5种类型并分析相关因素对其发生风险的影响。结果在纳入标准的212例急性缺血性卒中患者中,大动脉粥样硬化型99例（46.7%）、心源性卒中型35例（16.5%）、穿支动脉疾病45例（21.2%）、其他病因型5例（2.4%）、病因不确定型28例（13.2%）。吸烟者、高血压病、冠心病、心房颤动者在5亚型间比例差异具有统计学意义（P〈0.05）。相关和回归分析显示冠心病、心房颤动与心源性卒中亚型有正相关性（β=1.34、2.206,P〈0.05）,高血压病与穿支动脉疾病亚型有相关性,为正相关性（β=1.074,P〈0.05）。结论不同类型缺血性脑卒中与不同的危险因素有关,心房颤动、冠心病是心源性卒中亚型的危险因素,高血压病是穿支动脉疾病亚型的危险因素。     

Arterial ischemic stroke and hemorrhagic stroke in Chinese children: A retrospective analysis

To study the characteristics of pediatric arterial ischemic stroke (AIS) and hemorrhagic stroke (HS) in southwest of China, and analyze the etiology and risk factor. This study retrospectively reviewed the records of all patients in both department of neurology and department of neurosurgery in Children’s hospital of Chongqing medical university from January 2003 to March 2011, and patients were eligible for analysis if they had been diagnosed with AIS or HS. And SPSS 17.0 software was used for statistical analysis. The χ² test was used to exam relationships between stroke types and sex, age, and that between neuroradiological images and sex. 119 Boys (70.4%) and 50 girls (29.6%) were included. In these cases, HS accounted for the majority of the cases (n = 109, 64.1%), and vitamin K deficiency was a major etiology in 65 out of 109 HS (59.6%), most of which occurred in breastfeeding infants (87.7%) and those who received no vitamin K after birth. AIS accounted for 35.3% of the cases, and minor head injury associated stroke (40.0%) was more common than vasculopathy associated stroke (16.6%) and other kinds of stroke. HS in children is more common than AIS. Vitamin K deficiency was a major etiology in these young infants who experienced HS, and many cases of AIS were associated with minor head injury.     

缺血性脑卒中与血脂水平关系的初步分析

目的研究血脂异常与缺血性脑卒中及其各亚型的关系。方法收集516例缺血性脑卒中患者及131例非缺血性卒中对照组个体的血脂情况,包括血总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）等指标,对其进行统计分析比较。并将其中131例缺血性脑卒中患者根据TOAST分型标准进行分型,将各亚组的血脂水平与对照组再进行比较。结果缺血性脑卒中组的HDL水平明显低于对照组,TC／HDL比值明显高于较对照组。其余血脂成分,包括TC、TG、LDL则未发现存在显著差异。亚组比较中,大动脉粥样硬化性卒中（LAA）组、心源性脑栓塞（CE）组、小动脉闭塞性卒中或腔隙性卒中（SAO）组的HDL水平明显低干对照组,而他们的TC／HDL比值则明显高于对照。其余血脂成分比较未见统计学差异。其他原因卒中（SOE）及不明原因卒中（SUE）均显示与血脂各成分无相关性。结论HDL在缺血性脑卒中患者明显降低,其保护因素降低可能是卒中发生的原因之一。TC／HDL比值可作为衡量血脂异常与缺血性卒中关系的指标之一。需要进一步进行基于卒中分型基础上的更大样本量的研究。     

丁苯酞对急性缺血性脑卒中的保护作用

目的观察丁苯酞对急性缺血性脑卒中患者的保护作用。方法 80例患者随机分为对照组和治疗组(n=40)。采用酶联免疫吸附技术(ELISA)检测血清中超氧化物歧化酶(SOD)活性和丙二醛(MDA)含量的变化。结果与对照组相比,治疗组患者血清中SOD活性升高(P<0.05)、MDA含量减少(P<0.05),且治疗组有效率显著高于对照组(P<0.05)。结论丁苯酞对急性缺血性脑卒中具有良好的保护作用,其机制可能与其提高血清SOD活性、降低MDA含量及增强机体抗氧化能力有关。     

Posterior circulation ischemic stroke following Russell's viper envenomation

Ischemic stroke following viper bite is rare. We report a case of posterior circulation ischemic infarction following viper bite in a previously healthy woman. Soon after being bitten by the snake on the left leg, she developed local redness, echymosis and one hour later became drowsy. On examination she had skew deviation of eyes and down gaze preference, generalized hypotonia. A CT scan of brain showed infarcts in cerebellar hemispheres and occipital lobes on both sides and that was confirmed on magnetic resonance imaging of brain. Her coagulation profile was deranged. Most common and serious central nervous system complication following snake bite is intracranial hemorrhage. Ischemic stroke commonly involves anterior circulation. Bilateral cerebellar and occipital infraction is not yet reported in literature. Exact cause for the development of infarction is not clear. The possible mechanisms of infarction in this scenario are discussed. Patient was treated with anti-snake venom and showed a good recovery. Early imaging and early treatment with anti-snake venom is important for a favorable outcome.