5-脂氧合酶激活蛋白基因和白介素-1A基因多态与缺血性脑卒中的相关性

目的 探讨中国北方地区汉族人群5-脂氧合酶激活蛋白(ALOX5AP)基因和白介素-1A(IL-1A)基因多态与缺血性脑卒中(IS)的相关性.方法 采用病例-对照研究,检测构建ALOX5AP基因单倍型HapA的4个位点:SG13S25、SG13S32、SG13S89、SG13S114和IL-1A基因-889位点在对照组、IS组及IS亚组中多态的分布.结果 ALOXSAP基因SG13S114位点AA基因型可能是血栓性脑梗死独立的风险因素(OR=1.479,95% CI 1.024～2.135,P=0.037),且其风险性主要来源于A等位基因(OR=1.313,95% CI 1.017～1.693,P=0.036);IL-IA基因-889位点T等位基因可能是血栓性脑梗死的易患等位基因(OR=1.540,95% CI 1.075～2.204,P=0.023).HapA单倍型和IS没有相关性,GCGA单倍型可能是IS的危险单倍型(OR=1.683,95% CI 1.138～2.487,P=0.008).同时携带ALOX5AP基因GCGA单倍型和IL-1A-889T等位基因的个体患IS的风险性显著增加(OR=1.608,95% CI 1.607～2.423,P=0.022).结论 ALOXSAP基因、IL-1A基因的多态与IS具有相关性,二者的协同作用可显著增加IS的患病风险.     

Transoesophageal echocardiography in patients without arterial and major cardiac sources of embolism: difference between stroke subtypes

We studied the records of 175 consecutive patients referred to our neurologic ward between January 1994 and February 2000 with a diagnosis of ischaemic cerebrovascular disease (ICVD) (stroke or transient ischaemic attack - TIA) who underwent transoesophageal echocardiography (TEE). We excluded patients with large vessel disease, high-risk embolic cardiopathies and other rare causes of stroke. According to clinical and neuroimaging findings, patients were divided into two groups. The lacunar (LAC) group (69/175 (39.4%)) and the nonlacunar (N-LAC) one (106/175 (60.6%)). The control population consisted of 78 consecutive patients, referred to the echocardiography laboratory for TEE without history of ICVD and known heart disorders. Patent foramen ovale (PFO) frequency was significantly higher in case patients than in control subjects (55/175 (31.4%) vs. 13/78 (16.6%); p = 0.02). Among case patients, PFO was more prevalent in the N-LAC group than in the LAC one (43/106 (40.6%) vs. 12/69 (17.4%); p = 0.0005). A large degree of shunt occurred in 53.5% of N-LAC patients and in 16.7% of LAC ones (p = 0.04). Atrial septal aneurysm (ASA) was detected in 12% of case patients and 1.3% of control subjects (p = 0.003) and was more frequent in the N-LAC group than in the LAC one (16 vs. 5.8%; p = 0.05). Mitral prolapse (MP) was present in 6/175 (3.4%) ICVD patients (vs. 1/78 among controls) in most cases associated with myxomatous valve redundancy. Aortic arch atheromas (AA) were detected in 12% of ICVD patients and in 10.2% of controls. The frequency was 9.4% in N-LAC and 15.9 in LAC. No complicated AA (plaque thickness >4 mm, ulcerated atheroma, superimposed thrombus) were detected. After multivariate analysis, PFO (OR = 3.8; 95% CI = 2.7-7.9) and ASA (OR = 8.01; 95% CI = 3.0-16.1) appeared to be independent predictors of ICVD. PFO (OR = 2.24; 95% CI = 1.24-4.92) was also independently associated with N-LAC stroke subtype and its importance was even higher in younger patients. Our study provides further evidence that TEE is a helpful diagnostic tool in stroke patients without arterial and major cardiac sources of embolism. However, its utility differs according to type and localization of the ischaemic lesion being more relevant in patient with N-LAC infarctions.     

Cryptogenic stroke and patent foramen ovale: clinical clues to paradoxical embolism

BACKGROUND: Patent foramen ovale (PFO) is an independent risk factor for cerebral infarction. Since ~25% of the population have a PFO, the simple association of PFO with stroke is not enough to establish the diagnosis of paradoxical embolism. We evaluated possible clinical clues to the diagnosis of paradoxical embolism. METHODS: Among patients with cryptogenic ischemic stroke (CS) who were investigated for a right-to-left shunt (RLS), we compared clinical, coagulation and biochemical parameters in patients with PFO versus without PFO. RESULTS: Among 1689 new patients referred for TIA/non-disabling stroke between 2001 and 2007, 175 with cryptogenic stroke (CS) were investigated for RLS by transcranial Doppler (TCD) bubble studies; 89 (5.5%) with positive TCD had a PFO confirmed by TEE. In multivariate logistic regression, a history of DVT or pulmonary embolism (OR, 4.39; 95% CI, 1.23-15.69; p=0.023), prolonged travel (OR, 8.77; 95% CI, 1.775-43.3; p=0.008) , migraine (OR, 2.30: 95% CI, 1.07-4.92; p=0.031), a Valsalva maneuver preceding the onset of focal neurological symptoms (OR, 3.33; 95% CI, 1.15-9.64; p=0.026) and waking up with stroke/TIA (OR, 4.53, 95% CI, 1.26-16.2; p=0.018) were independently associated with PFO-associated cerebrovascular events. Patients with PFO had higher plasma total homocysteine levels than patients without PFO (8.9+/-3 versus 7.9+/-2.6 micromol/L respectively; p=0.021). CONCLUSIONS: A history of DVT or pulmonary embolism, migraine, recent prolonged travel, sleep apnea, waking up with TIA or stroke or a Valsalva maneuver preceding the event are clinical clues to the diagnosis of paradoxical embolism among patients with CS.     

Prevalence and Predictors of Stroke in Patients with Crohn's Disease: A Nationwide Study

ObjectivesMounting evidence points to the microbiome as a susceptibility factor for neurological disorders. Patients with Crohn's disease (CD) are at higher ischemic stroke (IS) risk, but no large scale epidemiologic studies have identified risk factors for stroke in this population.Materials and MethodsWe analyzed the 2017 Nationwide Inpatient Sample (NIS) dataset to identify patients with a discharge diagnosis of Crohn's disease using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code K50.X. We identified patients with a primary/secondary discharge diagnosis of IS using ICD-10-CM code I63.X. We compared sociodemographic and clinical variables between stroke and non-stroke patients with CD. Logistic regression analysis was applied to identify factors associated with IS.ResultsOf 30,212 patients with CD, 369 (1.2 %) had a discharge diagnosis of IS. Older age (odds ratio [OR], 1.03 [95% CI, 1.02–1.04], top quartile income (OR, 1.58 [95% CI, 1.10–2.30]), and hospitalization in a South Atlantic (OR, 1.82 [95% CI, 1.11-3.14]), East South Central (OR, 2.30 [95% CI, 1.28-4.25]), or West South Central hospital (OR, 2.40 [95% CI, 1.39-4.28]) were independently associated with IS. Clinical variables independently associated with IS in patients with CD included: atrial fibrillation (OR, 1.66 [95% CI, 1.15-2.33]), atherosclerosis (OR, 2.41 [95% CI, 1.32-4.10]), hyperlipidemia (OR, 1.69 [95% CI, 1.33-2.15]), hypertension (OR, 1.53 [95% CI, 1.18-1.98]) and valvular disease (OR, 1.62 [95% CI, 1.01-2.48).ConclusionA subset of traditional stroke risk factors are associated with IS in patients with CD. CD patients with these conditions could be targeted for vascular risk reduction and surveillance.     

Distribution of artificial cerebral microemboli in stroke patients with patent foramen ovale

Abstract

Objectives: Patent foramen ovale (PFO) is considered as an important risk factor for cerebrovascular diseases. Nevertheless, the relationship between the distribution of highintensity transient signals (HITS), resulting from injection of air mixed with saline and detected by transcranial Doppler (TCD), and clinical cerebrovascular syndromes in these patients has not been investigated.

Methods: Using TCD, we screened 40 patients with stroke or transient ischemic attack (TIA), in whom PFO was proven by transesophageal echocariography (TEE). Of these, 30 patients (75%) with artificially produced HITS either in the middle cerebral artery (MCA) or the basilar artery (BA) were included in the analysis.

Results: Nineteen patients had a stroke or TIA in the carotid territory and 11 patients in the vertebro-basilar territory. HITS were found in the MCA in all 30 patients and in 21 of the 30 patients in the BA. Of the latter, ten patients were in the carotid group and 11 patients were in the veretebro-basilar group, p=0.011.

Conclusion: There is a significant association between the distribution of artificial HITS and the clinical cerebrovascular syndromes.     

青年与中老年患者颅内大动脉粥样硬化性缺血性卒中影像学特点比较研究

目的 基于DWI影像对比青年和中老年大动脉粥样硬化性缺血性卒中(ischemic stroke,IS)患者病变分布特征的差异.方法 回顾性分析伴有颅内大动脉粥样硬化性狭窄/闭塞的IS患者颅脑DWI上IS病变的影像学数据.基于DWI上梗死灶分布特征,将病变分为单发、单区域多发和多区域多发IS病变,同时评估累及前后循环的情...     

Distribution of artificial cerebral microemboli in stroke patients with patent foramen ovale

OBJECTIVES: Patent foramen ovale (PFO) is considered as an important risk factor for cerebrovascular diseases. Nevertheless, the relationship between the distribution of high-intensity transient signals (HITS), resulting from injection of air mixed with saline and detected by transcranial Doppler (TCD), and clinical cerebrovascular syndromes in these patients has not been investigated. METHODS: Using TCD, we screened 40 patients with stroke or transient ischemic attack (TIA), in whom PFO was proven by transesophageal echocariography (TEE). Of these, 30 patients (75%) with artificially produced HITS either in the middle cerebral artery (MCA) or the basilar artery (BA) were included in the analysis. RESULTS: Nineteen patients had a stroke or TIA in the carotid territory and 11 patients in the vertebro-basilar territory. HITS were found in the MCA in all 30 patients and in 21 of the 30 patients in the BA. Of the latter, ten patients were in the carotid group and 11 patients were in the veretebro-basilar group, p = 0.011. CONCLUSION: There is a significant association between the distribution of artificial HITS and the clinical cerebrovascular syndromes.     

大脑中动脉分布区缺血性卒中患者的临床和影像学特征及复发危险因素

目的 分析大脑中动脉（middle cerebral artery,MCA）分布区非心源性缺血性卒中患者的临床和影像 学特征及复发的危险因素。 方法 连续入选发病7 d以内的MCA分布区非心源性缺血性卒中患者。收集患者的人口学信息、血管 病的危险因素和发病时的主要症状及体征,评价患者的头颅磁共振影像包括急性梗死灶的部位、 数量、分布特征、责任动脉有无狭窄、缺血性卒中的病因分型。随访患者1年内有无缺血性卒中或短暂 性脑缺血发作（transient ischemic attack,TIA）复发,通过多元Logistic回归分析患者复发的危险因素。 结果 研究共入组926例患者,责任MCA狭窄≥70%的患者（447例）常见多发梗死灶（338例,75.6%） 和分水岭梗死（317例,70.9%）,而责任MCA无狭窄或狭窄程度<70%患者（479例）常见MCA穿支分 布区单发梗死灶（247例,55.3%）。冠状动脉粥样硬化性心脏病[比值比（odds ratio,OR）7.55,95%可 信区间（confidence interval,CI）2.85～20.0,P <0.001]、缺血性卒中病史（OR 3.49,95%CI 1.52～8.01, P =0.003）、缺血性卒中发病前3个月内反复TI A史（OR 22.7,95%CI 8.35～61.6,P <0.001）、新发梗死 灶为多发（OR 5.26,95%CI 1.33～20.8,P =0.018）是患者1年内缺血性卒中或TIA复发的危险因素。 结论 对于非心源性缺血性卒中患者,MCA分布区梗死灶的分布特征与MCA狭窄程度有关。新发梗 死灶为多发、既往有缺血性心脑血管病病史的患者1年缺血性卒中或TIA复发风险高。     

Efficacy and acceptability of atypical antipsychotics for the treatment of post-traumatic stress disorder: A meta-analysis of randomized,double-blind,placebo-controlled clinical trials

As some evidences demonstrated that atypical antipsychotics (AA) may be efficacious in treating post-traumatic stress disorder (PTSD), we preformed a meta-analysis of randomized, double-blind, placebo-controlled clinical trials (RCTs) of AAs for the treatment of PTSD. Two hundred and fifty one papers were searched and screened. Eight RCTs met the inclusion criteria. AAs may be superior to placebo in the treatment of PTSD, as indicated by the changes in Clinician Administered PTSD Scale (CAPS) total scores (weighted mean differences (WMD)=−5.89, 95% confidence interval (CI) [−9.21, −2.56], P=0.0005) and also in CAPS subscale intrusion (WMD=−2.58, 95% CI[−3.83, −1.33], P<0.0001 ) and subscale hyperarousal (WMD=−2.94, 95% CI[−5.45, −0.43], P=0.02). The acceptability measured by dropout rates between AAs and placebo showed no statistical difference (OR=1.24, 95%CI [0.78, 1.97], P=0.36). PTSD symptom cluster, especially in intrusion and hyperarousal. However, we should be careful to generalize the conclusion because of the small number of included trails. We expect more RCTs will be done in the future so as to clarify the specific value of AAs for PTSD.     

Association of intercellular adhesion molecular-1 gene polymorphism in ischemic stroke patients

Background:

Ischemic stroke (IS) is a prevalent disease causing a body disability, the third leading cause of death in Taiwan. It shows that the level of intercellular adhesion molecular-1 (ICAM-1) in IS patients is higher than control subjects.

Objective:

This study is to investigate the possible association of ICAM-1 (G1548A) polymorphism in IS patients.

Materials and Methods:

A total of 646 subjects were enrolled in this study, including 312 IS patients, and 334 controls without a history of symptomatic IS. The ICAM-1 (G1548A) polymorphism was analyzed by polymerase chain reaction and restriction fragment length polymorphism. Clinical factors were also determined.

Results:

The frequencies of the ICAM-1 (G1548A) polymorphism for G/G, G/A, and A/A were 74.8%, 23.9%, and 0.3%, respectively, in healthy controls, and 62.8%, 32.1%, and 5.1%, respectively, in patients. The frequency of the ICAM-1 (G1548A) A allele (21.2% versus 13.2%, respectively; P = 0.007) and the carriers of the ICAM-1 (G1548A) A allele (37.2% versus 25.2%; P = 0.019, OR 1.76, 95% CI 1.1-2.83) are great in IS patients compared with healthy controls. There is a higher risk of IS associated with homozygosity for the ICAM-1 (G1548A) A allele (AA genotype) compared with the control population (5.1% vs. 0.3%, respectively, P = 0.04; OR 5.1, 95% CI 1.19-21.66). We also observed both hypertension and diabetes has shown a positive association with IS.

Conclusions:

The ICAM-1 (G1548A) polymorphism was associated with independent risk factor for the development of IS.     

Characteristics and Predictors of Aortic Plaques in Patients with Transient Ischemic Attacks and Strokes

OBJECTIVE: To identify the prevalence and characteristics of aortic atherosclerotic plaque disease and its association with cerebrovascular risk factors in patients with cerebral ischemic events. BACKGROUND: Aortic atheroma is associated with ischemic stroke. Its characteristics, including morphology and distribution among different stroke subtypes, are not well described. METHOD: From July 2000 to August 2001, all patients evaluated by transesophageal echocardiography (TEE) with diagnoses of transient ischemic attacks (TIAs) and strokes were prospectively studied. Demographics, including age, gender, ethnicity, cerebrovascular risk factors, and stroke subtypes, were collected. RESULTS: Thoracic aortic atheromas (TAAs) were present in 141 of 237 patients (59%) (mean age = 59 +/- 14, 119 [50%] male). Mild plaque (< 2 mm) was present in 13 of 237 (5%), moderate plaque (2-4 mm) in 49 (21%), severe plaque (> or = 4 mm) in 79 (33%), and complex plaque in 64 (27%). Patients' ages (odds ratio [OR] = 1.05, confidence interval [CI] 1.03-1.08, P < .001), coronary artery disease (OR = 2.2, CI 1.02-4.8, P < .042), and patent foramen ovale (PFO) (OR = 0.39, CI 0.22-0.70, P < .002) were associated with the severity and complexity of aortic plaque. In multivariate analysis, age (OR = 1.06, CI 1.03-1.08, P < .001) and the presence of PFO (OR = 0.35, CI 0.18-0.65, P < .001) continued to be significant to the severity and complexity of aortic atheroma. Gender, history of stroke, hypertension, diabetes mellitus, hyperlipidemia, and history of smoking were not associated with TAA. CONCLUSION: One third of TAA plaques are severe and complex in nature and more frequently present in the descending aorta and the arch of the aorta than in the ascending aorta. TEE should be considered for the early detection and treatment of TAA in patients without identified causes of stroke.     

Pre-existing brain damage and association between severity and prior cognitive impairment in ischemic stroke patients

BackgroundWe evaluated whether pre-existing brain damage may explain greater severity in cognitively-impaired patients with ischemic stroke (IS).MethodsIS patients were retrieved from the population-based registry of Dijon, France. Pre-existing damage (leukoaraiosis, old vascular brain lesions, cortical and central brain atrophy) was assessed on initial CT-scan. Association between prestroke cognitive status defined as no impairment, mild cognitive impairment (MCI), or dementia, and clinical severity at IS onset assessed with the NIHSS score was evaluated using ordinal regression analysis. Mediation analysis was performed to assess pre-existing brain lesions as mediators of the relationship between cognitive status and severity.ResultsAmong the 916 included patients (mean age 76.8 ± 15.0 years, 54.3% women), those with pre-existing MCI (n = 115, median NIHSS [IQR]: 6 [2-15]) or dementia (n = 147, median NIHSS: 6 [3-15]) had a greater severity than patients without (n = 654, median NIHSS: 3 [1-9]) in univariate analysis (OR=1.69; 95% CI: 1.18-2.42, p = 0.004, and OR=2.06; 95% CI: 1.49-2.84, p < 0.001, respectively). Old cortical lesion (OR=1.53, p = 0.002), central atrophy (OR=1.41, p = 0.005), cortical atrophy (OR=1.90, p < 0.001) and moderate (OR=1.41, p = 0.005) or severe (OR=1.84, p = 0.002) leukoaraiosis were also associated with greater severity. After adjustments, pre-existing MCI (OR=1.52; 95% CI: 1.03-2.26, p = 0.037) or dementia (OR=1.94; 95% CI: 1.32-2.86, p = 0.001) remained associated with higher severity at IS onset, independently of confounding factors including imaging variables. Association between cognitive impairment and severity was not mediated by pre-existing visible brain damages.ConclusionImpaired brain ischemic tolerance in IS patients with prior cognitive impairment could involve other mechanisms than pre-existing visible brain damage.     

Clinical features of cardioembolic strokes identified by transesophageal echocardiography

Clinical and CT scan features predictive of a cardiac source of embolism (CSOE) are helpful in planning appropriate investigations in ischaemic strokes. The currently described predictors of CSOE were determined before the availability of trans esophageal echocardiography (TEE). After the advent of TEE, many new CSOE were discovered. The present study was planned to investigate if the previously described predictors of CSOE are also valid for patients with CSOE detectable only with TEE (TEE-detected CSOE). From 1992-1995, 485 consecutive patients of ischemic stroke were enrolled in the Maryland Stroke Data Bank (MSDB). Patients with CSOE identified only by TEE and not by clinical, electrocardiographic or transthoracic echocardiographic (TTE) examination were compared to patients with a CSOE with respect to the features of the history, neurologic examination and CT scan. Of 485 patients with cerebral infarction, 132 (27%) patients had CSOE. In 21/132 (16%), diagnosis of high risk CSOE could be established only by TEE. The most discriminating clinical findings in TEE-detected CSOE patients were visual field deficit (OR 2.9; 95% CI, 1.1-7.4) and neglect (OR 3.4; 95% CI,1.2-9.3). Less strong associations were also found with other clinical features described previously for CSOE. No significant differences were found for features of the initial CT scan. In summary, presence of visual field defect and hemineglect may suggest a higher likelihood of finding a CSOE by TEE, even if the clinical cardiac examination and TTE are normal.     

Generalized tonic-clonic status epilepticus in the elderly in China.

The proportion of elderly people in China is projected to increase rapidly but there is limited information on status epilepticus (SE) in this population. We evaluated retrospectively the etiology, response to treatment, outcome and predictors of mortality in a group of elderly patients with generalized tonic-clonic SE in Hong Kong, China. Factors for increased mortality were analyzed using a logistic regression model. Of the 80 acute admissions for SE from two large urban hospitals over a seven-year period, 1996-2002, the two leading causes were attributed to cerebral infarct (n=28, 35%) and cerebral haemorrhage (n=14, 17.5%). The mean age was 74.2 years (range 60-93 years). At six months from the onset of seizures, 26 patients (32.5%) had made a good recovery but another 28 (35%) had died. Results showed that mortality was associated with increasing age (OR 1.08, 95% CI 1.01-1.16) and SE due to an acute symptomatic disturbance (OR 4.90, 95% CI 1.17-13.67). SE is associated with significant morbidity and mortality in this age group.     

Carotid plaque features on angiography and asymptomatic cerebral microembolism

We studied 110 carotid arteries of 55 patients with unilateral or bilateral carotid stenosis diagnosed with selective angiography, by using Transcranial Doppler to detect high intensity transient signals (HITS) in the middle cerebral arteries (MCAs). HITS identified as embolic signals were prevalent ( P <0.05) in the MCAs on the same side as severe (70–99%) stenosis (22 of 51=43.1%) compared to moderate (30–69%) stenosis (5 of 37=13.5%). No HITS were observed in the MCA on the same side as normal control carotid arteries ( n =17) [occluded arteries ( n =5) were not considered]. HITS were more prevalent ( P <0.05) in the MCAs on the same side as ulcerated plaques (14 of 23=60.9%) compared to non-ulcerated plaques (13 of 65=20%), and all moderate stenoses producing HITS presented ulceration of the plaque. Ulcerated plaque groups showed a higher mean number of HITS than non-ulcerated plaque groups and no significant difference was noted between moderate and severe stenosis, between superficial or deep ulcerations and between ulcerations with flap or without flap. Therefore, severe carotid stenosis and moderate stenosis with plaque ulceration result in angiographic findings most frequently associated with HITS. Further studies are necessary to evaluate the clinical significance of this finding.     

Changes in cardiac thrombus status after cerebral ischemia

BACKGROUND AND PURPOSE: Intracardiac thrombi are a potential source of cerebral embolism. The disposition of intracardiac thrombi in ischemic stroke/transient ischemic attack (TIA) patients was investigated over a 10-month period using omniplanar transesophageal echocardiography (TEE). METHODS: One hundred and five patients underwent TEE examination at <1 month and again at 9-12 months (mean 10 months) after symptom onset. TEEs were evaluated for thrombi in the left atrium, left atrial appendage and left ventricle. Stroke risk factors and TEE findings were compared between patients with and without new thrombi on follow-up TEE. Similar comparisons were made in patients with and without disappearance of thrombi on the follow-up TEE. The effect of anticoagulants was evaluated. RESULTS: Intracardiac thrombi were found initially in 18% (95% CI 11-25%) of patients in 79% (95% CI 61-97%) of whom the thrombi disappeared on the follow-up TEE; this significantly correlated with warfarin anticoagulation (p = 0.037). In the remainder 82% (95% CI 75-89%) patients, new thrombi were detected on the follow-up TEE in 8% (2-14%). These were older (p = 0.009), and not on anticoagulation. Patients with aortic atheroma >/=4 mm were also more likely to develop new intracardiac thrombi (p = 0.001). CONCLUSIONS: Anticoagulation with warfarin for 10 months is associated with conditions leading to disappearance of intracardiac thrombi after a cerebral ischemic event and hence has a probable therapeutic role. Older patients, not anticoagulated, and those with significant aortic atheroma >/=4 mm may have increased probability for de novo thrombus development. These patients may be at risk of cardiac embolization and could be considered for prophylactic anticoagulation.     

Mild left ventricular dysfunction is associated with thrombogenicity in cardioembolic stroke

BACKGROUND: Transesophageal echocardiography (TEE) has been recognized as a valuable tool for identifying the left cardiac thrombus (LCT) or spontaneous echocardiographic contrast (SEC). We aimed to identify risk groups where TEE should be performed in patients with suspected cardioembolic stroke according to magnetic resonance imaging analysis. METHODS: One hundred and forty-six patients (mean age 64.7 +/- 11.8 years, 101 males) with suspected cardioembolic stroke were analyzed. We used TEE for the presence of LCT and/or SEC as indication of thrombogenicity. We evaluated the association between thrombogenicity and demographic features, stroke risk factors and echocardiographic variables. RESULTS: The study included 40 patients (27.3%) who showed thrombogenicity (10 LCT and 30 SEC). The independent echocardiographic variables of thrombogenicity were atrial fibrillation (OR 7.14; 95% CI 2.62-19.48; p < 0.001) and left ventricular ejection fraction 相似文献   

Survey of blood pressure control status in patients with ischemic stroke or transient ischemic attack in China

OBJECTIVE: We sought to assess the current status of blood pressure control and the use of antihypertensive drugs in patients with ischemic stroke (IS) or transient ischemic attack (TIA) in China. SUBJECTS AND METHODS: A cross-sectional study (across 19 urban outpatient clinics) on secondary stroke prevention measures was conducted. All subjects diagnosed with IS or TIA at neurological clinics were enrolled consecutively. Face to face interviews were conducted by a trained neurologist and research assistant using questionnaire at the same day of enrollment. RESULTS: A total of 2283 IS or TIA patients were included in the survey. A history of hypertension was present in 1509 patients, of which 896 (59.4%) had uncontrolled blood pressure. A history of hypertension was absent in 603 patients, of whom 162 (26.9%) had uncontrolled blood pressure. In addition, 495 (88.9%) of patients with diabetes mellitus had uncontrolled blood pressure (systolic blood pressure > or = 130 mmHg or diastolic blood pressure > or = 80 mmHg). In multivariate logistic regression analysis, having monthly income of > 1000 yuan [odds ratio (OR): 2.040; 95% confidence interval (CI): 1.277-3.259), female (OR: 1.546; 95% CI: 1.174-2.034) and smoking habits (OR: 1.428; 95% CI: 1.014-2.013) remained significantly associated with blood pressure control. In contrast, compound preparation (OR: 0.685; 95% CI: 0.473-0.993) was inversely associated with the likelihood of blood pressure control. CONCLUSION: Blood pressure control rate among IS or TIA patients in major metropolitan clinics is an important issue in China which might largely influence the efforts in stroke prevention and treatment. Further works are needed to develop substantive quality improvement strategies of stroke secondary prevention care.     

Stroke Patients With Cardiac Atrial Septal Abnormalities: Differential Infarct Patterns on DWI

BACKGROUND: Stroke mechanism in patent foramen ovale (PFO) and/or atrioseptal aneurysm (ASA) remains unclear. We aimed to study the stroke pattern on diffusion weighted imaging (DWI), in cryptogenetic stroke according to septal abnormalities. METHODS: We prospectively evaluated 314 cryptogenetic strokes. Patients were categorized according to transesophageal echocardiography (TEE) findings: PFO with ASA, PFO alone, and no abnormalities. The study group consisted of 126 patients with acute DWI lesions within the first 7 days after the stroke onset. We considered the presence of scattered lesions or a cortico-subcortical territorial lesion as highly suggestive of an embolic pattern. RESULTS: PFO was identified in 77 patients (61%) and no alterations in 49 patients (39%). TEE revealed ASA in 42 patients (54.5% of PFO patients). An "embolic" pattern was depicted in 84 (66.7%) and subcortical in 42 (33.3%). An "embolic" pattern was significantly (P= .01) more frequently seen in PFO with ASA patients (n= 37;44%) as compared to PFO without ASA (n= 22; 26.2%) or no abnormalities (n= 25; 29.8%) on TEE. Univariate analysis revealed that age (P= .06), hyperlipidemia (P= .04), degree of shunt on TEE (P= .002), and the presence of an ASA (P= .008) were associated with an embolic pattern. After adjusting for sex, age, and vascular risk factors, only the presence of PFO, with ASA (OR 7.27; 95% CI 1.5-35.22 P= .014) was independently associated with an embolic pattern. CONCLUSION: In patients with cryptogenetic stroke, the presence of PFO with ASA, but not isolated PFO, is associated with an embolic pattern on DWI. These findings provide insights into the patho-mechanism of stroke in patients with PFO.     

Transcranial Doppler monitoring of cerebral embolism in atrial fibrillation and prosthetic valves. Clinical correlations

Transcranial Doppler (TCD) monitoring of the middle cerebral artery (MCA) permits the detection of high intensity transient signals (HITS), which are believed to represent microemboli. Non-valvular atrial fibrillation (NVAF) and prosthetic heart valves (PV) are important risk factors for embolic stroke. We evaluated both the prevalence and the frequency of microemboli in these high risk groups and the correlation with previous stroke. Sixty-six patients were monitored for 30 min on both MCAs sequentially. Twenty healthy subjects were studied as well. The total number of HITS recorded on both sides, expressed as HITS/h, was used for comparison. In NVAF patients (n = 24) the prevalence of HITS was 25%, in PV (n = 16) 62% and in those patients in whom PV coexisted with atrial fibrillation (PVAF) (n = 26), it was 42%. None in the control group showed HITS. HITS occurred significantly more frequently in PVAF (12.3/h) than in both NVAF (1.4/h, p = 0.007) and PV (2.7/h, p = 0.011), whereas there was no difference between PV and NVAF. The prevalence of HITS was not statistically different in patients with and without previous stroke, but among HITS positive patients those with previous stroke had a significantly higher HITS frequency (18.9 vs 8.5/h, p = 0.04). In conclusion, in patients with cardiac embolic sources the frequency of HITS increases from the classes with the lower (NVAF, PV) to the class with the highest (PVAF) risk factor. Patients with previous stroke have more HITS than asymptomatic ones. Therefore, embolus detection monitoring seems a promising tool in the assessment of the individual stroke risk in patients with cardiac embolic sources.