Quantitative Ischemic Characteristics and Prognostic Analysis of Crossed Cerebellar Diaschisis in Hyperacute Ischemic Stroke

ObjectivesCrossed cerebellar diaschisis (CCD) is a secondary phenomenon caused by supratentorial brain injury, characterized by hypoperfusion and hypometabolism of the contralateral cerebellum. This study aimed to investigate the correlation between the quantitative data of initial supratentorial ischemia and CCD, and to further explore the prognosis value of CCD in the hyperacute phase.Materials and MethodsThe imaging and clinical data of 109 patients with hyperacute ischemic stroke were analyzed retrospectively, univariate analysis and multivariate logistic regression were used to observe the relationship between the volume and degree of initial supratentorial ischemia and CCD, respectively, and to further analyze the effects of CCD in the hyperacute phase on neurological function and clinical prognosis.ResultsThe degree and volume of initial supratentorial ischemia was significantly correlated with hyperacute CCD. The volume of ischemic penumbra (OR=1.021 [95% CI: 1.009–1.033], P<0.001) and the reduction rate of cerebral blood volume (CBV) (OR=1.338 [95% CI: 1.073–1.668], P=0.01) were the main influencing factors of CCD; patients with hyperacute CCD had higher admission and discharge National Institutes of Health Stroke Scale (NIHSS) (P=0.046 and P=0.01), and more hemorrhagic transformation (P=0.021), but there was no significant difference in the final infarction volume (P=0.347) and the 90-day modified Rankin Scale (mRS) (P=0.757).ConclusionPatients with CCD had larger initial supratentorial ischemic volume and more severe ischemic degree in the hyperacute ischemic stroke, more short-term neurological impairment, and worse short-term treatment effect, however, but the long-term functional prognosis was not be affected.     

缺血性卒中的遗传机制进展

卒中是危害国人健康的头号杀手,目前每年的发病率为8.7%,积极寻找更为有效的卒中防治策略始终是对医学界的挑战。大多数卒中是遗传与环境危险因素共同作用的结果。环境因素已报告200多种,已明确的危险因素包括老龄、男性、吸烟、饮酒、糖尿病、高血压和卒中家族史、心房颤动等;但仍有20%～50%的卒中惠者没有携带已确立的危险因素。有关卒中发病的遗传因素所知更少。中国人群心脑血管病发病特点与西方人不同,如卒中与冠心病之比为4～5:1,而西方白人人群是1:2;中国人群脑出血发病率高,占卒中类型的40%～50%,而在西方人群中仅占10%～20%。因此,采用系统生物学方法,将流行病学、基因组学、群体遗传学、分子生物学以及生物信息学等多个学科有机地结合起来,确立中国人群卒中发病的新的易感基因和环境因素,对指导卒中的预防与治疗有重要意义。本期专题密切跟踪近年来国内外有关卒中的基因组学和遗传学研究进展,较全面地阐述了卒中的遗传机制,期望起到一个抛砖引玉的作用,以使更多临床医生和基础研究者在卒中研究领域有更多创新性发现。惠汝太,张伟丽     

Recent Advances in the Genetics of Cerebellar Ataxias

The hereditary cerebellar ataxias are a clinically and genetically heterogeneous group of disorders that primarily affect the cerebellum; often there are additional features such as neuropathy, cognitive decline, or maculopathy that help define the clinical subtype of ataxia. They are commonly classified according to their mode of inheritance into autosomal dominant, autosomal recessive, X-linked, and mitochondrial forms. Great advances have been made in understanding the genetics of cerebellar ataxias in the last 15 years. At least 36 different forms of ADCA are known, 20 autosomal-recessive, two X-linked, and several forms of ataxia associated with mitochondrial defects are known to date. However, in about 40 % of suspected genetically determined ataxia cases, the underlying genetic defect remains undetermined. Although the majority of disease genes have been found in the last two decades, over the last 2 years the genetics has undergone a methodological revolution. New DNA sequencing technologies are enabling us to investigate the whole or large targeted proportions of the genome in a rapid, affordable, and comprehensive way. Exome and targeted sequencing has recently identified four new genes causing ataxia: TGM6, ANO10, SYT14, and rundataxin. This approach is likely to continue to discover new ataxia genes and make screening of existing genes more effective. Translating the genetic findings into isolated and overlapping disease pathways will help stratify patient groups and identify therapeutic targets for ataxia that have so far remained undiscovered.     

叶酸与缺血性卒中关系的研究进展

缺血性卒中是我国人口的首位死亡原因,高同型半胱氨酸血症是缺血性卒中的独立危险因素之一,补充叶酸能降低血浆同型半胱氨酸水平。本文就叶酸对缺血性卒中的一级预防和二级预防的作用、影响因素及补充叶酸的建议等研究进行综述,为卒中的预防提供新的治疗方法与思路。     

Ischemic Stroke Predictors in Patients Presenting with Dizziness,Imbalance, and Vertigo

Objects

To identify predictors of acute ischemic stroke (AIS) among patients presenting to the Emergency Department (ED) with dizziness, imbalance, or vertigo (DIV) based on demographic and clinical characteristics.

非心源性缺血性卒中近期再发危险因素分析

目的 探讨首发非心源性缺血性卒中且二级预防药物依从性好的患者近期再发的相关危险因素。      

Epileptic Syndromes in Infancy and Childhood: Recent Advances

Summary: Epileptic syndromes are more reliable than etiology in determining prognosis and optimal treatment in infants and children. Benign neonatal and infantile convulsions are either idiopathic or dominantly inherited, the latter being genetically nonallelic. Forms of idiopathic generalized epilepsy (IGE) include absence epilepsy, benign myoclonic epilepsy of infancy, and epilepsy with generalized myoclonic atonic seizures. Forms of idiopathic partial epilepsy include benign partial epilepsy with centrotemporal spikes (BECT), benign partial epilepsy with occipital paroxysms, idiopathic partial epilepsy with affective seizures, and benign partial epilepsies with extreme somatosensory evoked potentials (SEPS). These idiopathic epilepsies appear to result from a multifactorial genetic predisposition. The diagnosis is based on strict clinical and EEG criteria. In epileptogenic encephalopathies, cognitive disorders are the main feature and are linked to so–called interictal abnormalities. Some epileptic syndromes, particularly myoclonic epilepsies, remain unclassifiable because of poor understanding of nosology or heterogeneous outcome.     

急性缺血性卒中静脉溶栓治疗研究新进展

随着静脉溶栓时间窗从3 h扩展到了9 h,研究重点也从时间窗理念扩展至组织窗理念。对 于发病时间不明、醒后卒中或者一定时间内的超时间窗患者,需完善相关神经影像学检查,权衡利弊 后决定是否静脉溶栓治疗。本文重点梳理了近年来根据组织窗寻找静脉溶栓获益患者的各种不同 筛选方法及静脉溶栓的药物选择,希望能为临床提供参考。     

急性缺血性卒中静脉溶栓治疗研究新进展

随着静脉溶栓时间窗从3 h扩展到了9 h，研究重点也从时间窗理念扩展至组织窗理念。对
于发病时间不明、醒后卒中或者一定时间内的超时间窗患者，需完善相关神经影像学检查，权衡利弊
后决定是否静脉溶栓治疗。本文重点梳理了近年来根据组织窗寻找静脉溶栓获益患者的各种不同
筛选方法及静脉溶栓的药物选择，希望能为临床提供参考。     

Positional Vertigo After Isolated Cerebellar Nodulus Stroke: A Report of 3 Cases

We report 3 cases (69-year-old man, 71-year-old man, and 82-year-old woman) of isolated cerebellar nodulus stroke patients, who presented with positional vertigo alone that lasted only for 2-4 days. Brain magnetic resonance imaging helped diagnosing these cases. Although rare, clinicians should be aware of isolated cerebellar nodulus stroke, when facing with patients with paroxysmal vertigo of acute onset.     

脑血流自动调节功能在卒中应用的研究进展

【摘要】 脑血流自动调节（cerebral autoregulation,CA）是大脑维持脑血流量（cerebral blood flow,
CBF）相对恒定的主要机制,对于大脑各种生理功能的正常发挥和多种疾病的发生、发展和转归均有
至关重要的意义。随着测量技术的不断发展,CA逐渐走入临床各个领域,并逐渐开始为临床提供更
多的参考信息。本文就卒中对CA的影响及CA与疾病预后的关系进行了总结。     

血管新生与缺血性卒中的相关性研究进展

卒中后遗留的神经功能障碍的治疗一直是困扰人类的医学难题之一。最近的研究表明,脑缺血后神经元的修复不仅与各种生长因子有关,还取决于缺血区血管新生(angiogenesis)的能力。了解血管新生和卒中的关系有助于促进卒中后血管新生的研究,并促进缺血性卒中的治疗。本文将目前缺血性卒中与血管新生的研究进展概述如下。     

小卒中的临床研究现状

近年来,关于小卒中的讨论日渐热烈,而对于其定义却尚不明确。本文总结发现小卒中与短暂脑缺血发作相比,虽然两者危险因素及临床表现均相似,但小卒中的预后较差。通过对其病理基础和影像学表现的分析,发现小卒中反复再发可能导致神经心理方面的不良预后。因此,应在急性期积极治疗小卒中患者,尽早启动脑卒中二级预防减少脑卒中的再发。     

他汀类药物治疗缺血性卒中的研究进展

缺血性卒中是影响伤残调整寿命年的最主要原因之一。他汀类药物为羟甲基戊二酰辅酶 A还原酶抑制剂,已被多国指南推荐用于缺血性卒中的一级和二级预防,本文就他汀类药物对缺血 性卒中的治疗效果,他汀类药物治疗缺血性卒中可能的机制及安全性作一综述,供临床探讨     

Thyroid Hemorrhage Causing Airway Obstruction After Intravenous Thrombolysis for Acute Ischemic Stroke

Background

There are several life-threatening complications associated with intravenous thrombolysis after acute ischemic stroke such as symptomatic intracerebral hemorrhage, orolingual angioedema, or less frequent, bleedings of the mucosa or ecchymosis. Aside from these known critical incidents, rare and unfamiliar complications may be even more challenging, as they are unexpected and may mimic events that appear more frequently. We report a rare and unusual acute complication of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) (0.9 mg/kg) administered for acute ischemic stroke.

Methods

Medical records, radiologic imaging, and pathologic specimens were reviewed.

Results

A 86-year-old woman developed acute respiratory failure 20 h after thrombolysis with suspected angioedema triggered by intravenous rt-PA. The inspiratory stridor and dyspnea were unresponsive to bronchodilators, corticosteroids, and inhaled adrenaline. After endotracheal intubation, laryngoscopy showed no significant supraglottic narrowing. Thyroidal sonography and cervical computed tomography revealed a thyroidal mass causing a tracheal and vascular compression compatible with thyroidal hemorrhage. Sonography showed a nodular goiter of the right thyroid gland. A total thyroidectomy was performed and histologic analysis confirmed a hemorrhage of the right thyroidal lobe.

Conclusions

Acute airway obstruction with respiratory failure due to thyroidal hemorrhage after intravenous thrombolysis is an important life-threatening complication, mimicking an anaphylactic reaction or a more frequent orolingual angioedema.