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Ojha R, Huang D, An H, Liu R, Du C, Shen N, Tu Z, Li Y. Distribution of ischemic infarction and stenosis of intra- and extracranial arteries in young Chinese patients with ischemic stroke. BMC Cardiovasc Disord 2015; 15:158. [PMID: 26597918 PMCID: PMC4657340 DOI: 10.1186/s12872-015-0147-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 11/10/2015] [Indexed: 01/10/2023] Open
Abstract
Background The distribution of cerebral ischemic infarction and stenosis in ischemic stroke may vary with age-group, race and gender. This study was conducted to understand the risk factors and characteristics of cerebral infarction and stenosis of vessels in young Chinese patients with ischemic stroke. Methods This was a retrospective study, from January 2007 to July 2012, of 123 patients ≤50 years diagnosed with acute ischemic stroke. Patient characteristics were compared according to sex (98 males and 25 females) and age group (51 patients were ≤45 years and 72 patients were 46–50 years). Characteristics of acute ischemic infarction were studied by diffusion weighted imaging. Stenosis of intra- and extracranial arteries was diagnosed by duplex sonography, head magnetic resonance angiography (MRA) or cervical MRA. Results Common risk factors were hypertension (72.4 %), dyslipidemia (55.3 %), smoking (54.4 %) and diabetes (33.3 %). Lacunar Infarction was most common in our patients (41.5 %). Partial anterior circulation infarction was predominant in females (52.0 vs 32.7 %; P = 0.073) and posterior circulation infarction in males (19.8 vs 4 %; P = 0.073). Multiple brain infarctions were found in 38 patients (30.9 %). Small artery atherosclerosis was found in 54 patients (43.9 %), with higher prevalence in patients of the 46–50 years age-group. Intracranial stenosis was more common than extracranial stenosis, and middle cerebral artery stenosis was most prevalent (27.3 %). Stenosis in the anterior circulation was more frequent than in the posterior circulation (P < 0.001). Conclusions In these young patients, hypertension, smoking, dyslipidemia and diabetes were common risk factors. Intracranial stenosis was most common. The middle cerebral artery was highly vulnerable.
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Affiliation(s)
- Rajeev Ojha
- Department of Neurology, East Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200120, China.
| | - Dongya Huang
- Department of Neurology, East Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200120, China.
| | - Hedi An
- Department of Neurology, East Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200120, China.
| | - Rong Liu
- Department of Neurology, East Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200120, China.
| | - Cui Du
- Department of Neurology, East Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200120, China.
| | - Nan Shen
- Department of Neurology, East Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200120, China.
| | - Zhilan Tu
- Department of Neurology, East Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200120, China.
| | - Ying Li
- Department of Neurology, East Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200120, China.
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Narayanaswami P, Weiss M, Selcen D, David W, Raynor E, Carter G, Wicklund M, Barohn RJ, Ensrud E, Griggs RC, Gronseth G, Amato AA. Evidence-based guideline summary: diagnosis and treatment of limb-girdle and distal dystrophies: report of the guideline development subcommittee of the American Academy of Neurology and the practice issues review panel of the American Association of Neuromuscular & Electrodiagnostic Medicine. Neurology 2014; 83:1453-63. [PMID: 25313375 DOI: 10.1212/wnl.0000000000000892] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To review the current evidence and make practice recommendations regarding the diagnosis and treatment of limb-girdle muscular dystrophies (LGMDs). METHODS Systematic review and practice recommendation development using the American Academy of Neurology guideline development process. RESULTS Most LGMDs are rare, with estimated prevalences ranging from 0.07 per 100,000 to 0.43 per 100,000. The frequency of some muscular dystrophies varies based on the ethnic background of the population studied. Some LGMD subtypes have distinguishing features, including pattern of muscle involvement, cardiac abnormalities, extramuscular involvement, and muscle biopsy findings. The few published therapeutic trials were not designed to establish clinical efficacy of any treatment. PRINCIPAL RECOMMENDATIONS For patients with suspected muscular dystrophy, clinicians should use a clinical approach to guide genetic diagnosis based on clinical phenotype, inheritance pattern, and associated manifestations (Level B). Clinicians should refer newly diagnosed patients with an LGMD subtype and high risk of cardiac complications for cardiology evaluation even if they are asymptomatic from a cardiac standpoint (Level B). In patients with LGMD with a known high risk of respiratory failure, clinicians should obtain periodic pulmonary function testing (Level B). Clinicians should refer patients with muscular dystrophy to a clinic that has access to multiple specialties designed specifically to care for patients with neuromuscular disorders (Level B). Clinicians should not offer patients with LGMD gene therapy, myoblast transplantation, neutralizing antibody to myostatin, or growth hormone outside of a research study designed to determine efficacy and safety of the treatment (Level R). Detailed results and recommendations are available on the Neurology® Web site at Neurology.org.
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Affiliation(s)
- Pushpa Narayanaswami
- From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Michael Weiss
- From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Duygu Selcen
- From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - William David
- From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Elizabeth Raynor
- From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Gregory Carter
- From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Matthew Wicklund
- From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Richard J Barohn
- From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Erik Ensrud
- From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Robert C Griggs
- From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Gary Gronseth
- From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Anthony A Amato
- From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA
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