[Silent brain infarcts]

Atrophic papulosis (Köhlmeier-Degos disease) revisited. A cross-sectional study on 105 patients

BACKGROUND

Atrophic papulosis is a very rare vascular disease of unknown pathogenesis, mostly described by case reports.

OBJECTIVE

To assess demographic data and prognosis in patients with atrophic papulosis.

METHODS

Single-centre study on a series of 105 patients with atrophic papulosis, diagnosed 2000-2021. Patients referred and diagnosed at the evaluation centre and patients' clinical data provided by the Degos Support Network and evaluated by the authors for confirming diagnosis for skin lesions and fulfilling the diagnostic criteria for a malignant subset. A unique set of variables was collected from all patients.

RESULTS

The mean age of disease onset was 33.3±18.3 years and the male-to-female ratio 1:1.6. The family history rate was 8.1%. The classification into a benign, merely cutaneous one (benign atrophic papulosis), and malignant atrophic papulosis, associating cutaneous and visceral lesions was confirmed due to their striking prognostic difference. Benign atrophic papulosis was detected in 41% of the patients with no deaths occurring throughout the follow-up period (median 3.00 years; range 0.13-23). Malignant atrophic papulosis was reported in 59% of patients with 47.5% multisystemic involvement and a median skin lesion onset to systemic symptoms duration of 0.54 years (-6 to 20). Gastrointestinal tract and central nervous system were equally involved; however, the neurological sign-caused death rate was slightly higher. The disease-specific mortality rate of malignant atrophic papulosis was 22.6%.

CONCLUSIONS

Atrophic papulosis presents with striking prognostic difference of benign - merely cutaneous - involvement or quickly developing - into less than one year - malignant subset, associating cutaneous and visceral lesions and multiorgan involvement in 1/2 of the patients, which leads to premature, disease-specific mortality in 1/4 of the cases. Central nervous system and gastrointestinal tract involvement complications are the major reasons for disease-specific death. Over the years the diagnosis of severe nervous system involvement has become more common.

Predicting new silent cerebral infarction after intracerebral hemorrhage using serum white blood cell count

Background

It has been confirmed that incidental silent cerebral infarctions (SCIs) found in healthy people may be risk factors for cerebrovascular diseases such as strokes and vascular dementia. The prospective study aimed to determine the utility of baseline serum white blood cell (WBC) counts to predict the emergence of new SCI after intracranial hemorrhage (ICH).

Methods

This is a prospective study. From January 2016 to December 2017, we recruited 171 patients admitted to the neurology department of the Affiliated Shuyang Hospital of Xuzhou Medical University with a first episode of ICH. Serum WBC count was measured on admission. SCI was detected by cranial magnetic resonance imaging (MRI) 14 days after the onset of the ICH. Receiver operating characteristic curve analysis was used to calculate the most appropriate cut-off values of the WBC count for differentiating patients with and without SCI at the end of the study period.

Results

New SCIs were detected in 28.07% of patients by cranial MRI. Multivariate logistic regression analysis showed that cerebral microbleeds (CMBs), raised WBC counts, and leukoaraiosis were independent risk factors for SCI. The most appropriate cut-off WBC count differentiating the two groups was 7.65×10⁹/L (sensitivity: 77.08%, specificity: 63.41%).

Conclusion

Elevated levels of serum WBC counts in patients with ICH are associated with SCI. There is potential value in using serum WBC counts to predict new SCI after an acute hemorrhagic stroke.

[Not Available]

Zusammenfassung. Unser Gehirn verändert sich mit zunehmendem Alter. Dieser physiologische Prozess kann mithilfe von Magnetresonanztomografie (MRT) beschrieben werden. Im Laufe des Lebens kommt es zu Atrophie (Schrumpfen von Hirnstrukturen) sowie Auftreten von charakteristischen MRT-Signal-Hyperintensitäten in der weissen Substanz. Eine besonders starke oder frühe Ausprägung dieser Veränderungen kann pathologisch sein. Die Abgrenzung zwischen gesundem Altern und Prozessen mit Krankheitswert ist dabei nicht einfach. In diesem Mini-Review sollen normale Alterungsprozesse des Gehirns beschrieben und krankhafte Veränderungen aufgezeigt werden, die weiterer Abklärung und Behandlung bedürfen.

[Pathomorphological characteristics and risk factors of asymptomatic cerebral infarction based on the results of a cross-sectional hospital-based study]

AIM

To study the prevalence, pathomorphological characteristics and risk factors of asymptomatic cerebral infarction (CI) based on the results of post-mortem studies and clinical charts of patients.

MATERIAL AND METHODS

The autopsies of 735 patients died due to different diseases were analyzed using continuous sampling method. CI lesions were found in 86 patients (47 women, 39 men, mean age 76.3±10.5 years). Morphological parameters of CI and cardiovascular risk factors were analyzed.

RESULTS AND CONCLUSION

There were mean 2.7±1.5 CI lesions per patient in the main group: 47 (54.6%) patients had ≥3 lesions, 9 (10.5%) - 2 lesions and 30 (34.9%) - 1 lesion. The significantly higher frequency of cardiovascular risk factors was found in CI patients (arterial hypertension, diabetes mellitus, atrial fibrillation, tobacco smoking) while the adherence to prevention strategies was lower compared to patients without CI.

Atrial fibrillation and silent stroke: links, risks, and challenges

Atrial fibrillation (AF) is the most common cardiac arrhythmia, with a projected number of 1 million affected subjects in Germany. Changes in age structure of the Western population allow for the assumption that the number of concerned people is going to be doubled, maybe tripled, by the year 2050. Large epidemiological investigations showed that AF leads to a significant increase in mortality and morbidity. Approximately one-third of all strokes are caused by AF and, due to thromboembolic cause, these strokes are often more severe than those caused by other etiologies. Silent brain infarction is defined as the presence of cerebral infarction in the absence of corresponding clinical symptomatology. Progress in imaging technology simplifies diagnostic procedures of these lesions and leads to a large amount of diagnosed lesions, but there is still no final conclusion about frequency, risk factors, and clinical relevance of these infarctions. The prevalence of silent strokes in patients with AF is higher compared to patients without AF, and several studies reported high incidence rates of silent strokes after AF ablation procedures. While treatment strategies to prevent clinically apparent strokes in patients with AF are well investigated, the role of anticoagulatory treatment for prevention of silent infarctions is unclear. This paper summarizes developments in diagnosis of silent brain infarction and its context to AF.