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Gao Y, Zong C, Yao Y, Zhao H, Song Y, Zhang K, Yang H, Liu H, Wang Y, Li Y, Yang J, Song B, Xu Y. Elevated Fibrinogen-to-Albumin Ratio Correlates with Incident Stroke in Cerebral Small Vessel Disease. J Inflamm Res 2024; 17:4331-4343. [PMID: 38979435 PMCID: PMC11230119 DOI: 10.2147/jir.s466879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 06/15/2024] [Indexed: 07/10/2024] Open
Abstract
Purpose We aimed to explore the association between fibrinogen-to-albumin ratio (FAR) and the risk of incident stroke (IS) in a cohort of cerebral small vessel disease (CSVD) patients. Patients and Methods Participants were screened from a prospective CSVD database. Clinical data, hematologic measures and imaging findings were collected. The primary outcome was IS during follow-up, with a secondary outcome of composite vascular events (CVE) including IS, myocardial infarction (MI), and vascular deaths. Univariate and multivariate COX proportional risk models, along with competing risk models, were employed to identify factors associated with outcomes. Restricted cubic spline (RCS) and subgroup analyses were conducted to assess the association between FAR and the risk of IS and CVE in CSVD patients. Results In the final analysis of 682 CSVD patients over a median observation period of 34.0 [24.0-53.0] months, there were 33 cases of IS (4.84%, 1.55/100 person-years), 4 incidents of MI (0.59%, 0.19/100 person-years), 15 non-vascular deaths (2.20%, 0.70/100 person-years), and 37 occurrences of CVE (5.43%, 1.74/100 person-years). Multivariate Cox regression analysis revealed a significant positive correlation between elevated FAR and both IS (HR 1.146; 95% CI 1.043-1.259; P=0.004) and CVE (HR 1.156; 95% CI 1.063-1.257; P=0.001) in CSVD patients. Multivariate competing risk model showed the similar results (IS: HR 1.16; 95% CI 1.06-1.27; P=0.001, CVE: HR 1.15; 95% CI 1.05-1.26; P=0.003). RCS analysis indicated a linear relationship between FAR and the risks of both IS (P for non-linearity =0.7016) and CVE (P for non-linearity =0.6475), with an optimal cutoff value of 8.69, particularly in individuals over 60 years of age. Conclusion Elevated FAR demonstrated an independent and linear association with IS and the development of CVE in CSVD patients.
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Affiliation(s)
- Yuan Gao
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, People's Republic of China
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, Henan, People's Republic of China
| | - Ce Zong
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Ying Yao
- School of Health and Nursing, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Haixu Zhao
- School of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yuan Song
- School of Health and Nursing, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Ke Zhang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Hongxun Yang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Hongbing Liu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yunchao Wang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yusheng Li
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, People's Republic of China
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, Henan, People's Republic of China
| | - Jing Yang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, People's Republic of China
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, Henan, People's Republic of China
| | - Bo Song
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, People's Republic of China
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, Henan, People's Republic of China
| | - Yuming Xu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, People's Republic of China
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, Henan, People's Republic of China
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Sung MF, Lim JH. Ataxic hemiparesis: a narrative review for clinical practice in rehabilitation. Top Stroke Rehabil 2024; 31:537-545. [PMID: 37965878 DOI: 10.1080/10749357.2023.2281722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/04/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Ataxic hemiparesis (AH) is a well-recognized clinical lacunar stroke syndrome, characterized by paresis with ataxia on the same side of the body. It affects patients with stroke involving the basal ganglia, pons, internal capsule, corona radiata, and thalamus. In the past, lacunar syndrome denotes good functional recovery with low mortality and morbidity rate. However, recent evidence suggests AH has an association with more debilitating outcomes in the long term. OBJECTIVE To provide a comprehensive narrative review of published literatures on the topics related with AH and update clinical practice including rehabilitation. METHODS Literature review was performed by using the keywords "Subcortical Ataxia," "Lacunar Stroke," "Diaschisis", and "Ataxic Hemiparesis" on PubMed and Google Scholar Engines from 1978 to 2022. All papers published in English were reviewed and manual search of references from retrieved literature was performed for other relevant articles. RESULTS A comprehensive review was carried out on the following topics: neuroanatomical localization, pathogenesis, clinical features and clinical assessment scales, pharmacological and non-pharmacological modalities for ataxia treatment, prognosis, and outcome. CONCLUSION AH imposes significant challenges on stroke survivors when it comes to remediation of balance and coordination. It is associated with increased risk of mortality, stroke recurrence, and dementia. Though application of the concept of neuroplasticity and the utilization of repetitive transcranial magnetic stimulation have shown early promising results, further research is needed to establish the practice guidelines for rehabilitation of patients with AH.
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Affiliation(s)
- Mei-Fen Sung
- Division of Rehabilitation Medicine, University Medicine Cluster, National University Hospital, Singapore
| | - Jeong Hoon Lim
- Division of Rehabilitation Medicine, University Medicine Cluster, National University Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Lin J, Si Z, Wang A. Predictive value of ApoB/ApoA-I for recurrence within 1 year after first incident stroke. Front Neurol 2024; 14:1308442. [PMID: 38274879 PMCID: PMC10808791 DOI: 10.3389/fneur.2023.1308442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
Background ApoB/ApoA-I ratio is a reliable indicator of cholesterol balance, particularly in the prediction of ischemic events risk. The aim of this study was to investigate the prognostic value of ApoB/ApoA-I for stroke recurrence within 1 year after the first incident. Methods We retrospectively included patients who were first diagnosed with acute (<7 days after onset) ischemic stroke. Blood samples were collected on admission, and serum ApoB and ApoA-I concentrations were measured. We analyzed the relationship between ApoB/ApoA-I ratio and ischemic stroke recurrence within 1 year. Results A total of 722 patients with acute ischemic stroke were included, of whom 102 experienced stroke recurrence within 1 year, with a recurrence rate of 14.1%. Serum ApoB/ApoA-I concentrations on admission were higher in patients with stroke recurrence at 1 year compared with those with a good prognosis (P < 0.001). The Kaplan-Meier survival curve revealed a significant difference in cumulative stroke recurrence rates across ApoB/ApoA-I tertiles (log-rank P-value < 0.001). A positive correlation between the ApoB/ApoA-I ratio and the risk of stroke recurrence within 1 year was demonstrated using Cox regression analysis, which remained significant after adjusting for traditional risk factors [hazard ratio (HR) 4.007, 95% confidence interval (CI) 1.661-9.666]. This relationship was particularly strong in patients with LAA stroke (HR 4.955, 95% CI 1.591-15.434). Subgroup analysis further revealed that a high ApoB/ApoA-I ratio was strongly associated with stroke recurrence regardless of whether patients had high or low LDL-C levels. Discussion ApoB/ApoA-I ratio, measured during the acute phase of the first stroke, was positively correlated with the risk of stroke recurrence within 1 year.
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Affiliation(s)
- Jie Lin
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Shandong Institute of Neuroimmunology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong, China
| | - Zhihua Si
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong, China
| | - Aihua Wang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong, China
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Li N, Li YL, Li LT. Development and validation of a nomogram predictive model for cerebral small vessel disease: a comprehensive retrospective analysis. Front Neurol 2024; 14:1340492. [PMID: 38259650 PMCID: PMC10801164 DOI: 10.3389/fneur.2023.1340492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Background Cerebral small vessel disease (CSVD) is a significant contributor to stroke, intracerebral hemorrhages, and vascular dementia, particularly in the elderly. Early diagnosis remains challenging. This study aimed to develop and validate a novel nomogram for the early diagnosis of cerebral small vessel disease (CSVD). We focused on integrating cerebrovascular risk factors and blood biochemical markers to identify individuals at high risk of CSVD, thus enabling early intervention. Methods In a retrospective study conducted at the neurology department of the Affiliated Hospital of Hebei University from January 2020 to June 2022, 587 patients were enrolled. The patients were randomly divided into a training set (70%, n = 412) and a validation set (30%, n = 175). The nomogram was developed using multivariable logistic regression analysis, with variables selected through the Least Absolute Shrinkage and Selection Operator (LASSO) technique. The performance of the nomogram was evaluated based on the area under the receiver operating characteristic curve (AUC-ROC), calibration plots, and decision curve analysis (DCA). Results Out of 88 analyzed biomarkers, 32 showed significant differences between the CSVD and non-CSVD groups. The LASSO regression identified 12 significant indicators, with nine being independent clinical predictors of CSVD. The AUC-ROC values of the nomogram were 0.849 (95% CI: 0.821-0.894) in the training set and 0.863 (95% CI: 0.810-0.917) in the validation set, indicating excellent discriminative ability. Calibration plots demonstrated good agreement between predicted and observed probabilities in both sets. DCA showed that the nomogram had significant clinical utility. Conclusions The study successfully developed a nomogram predictive model for CSVD, incorporating nine clinical predictive factors. This model offers a valuable tool for early identification and risk assessment of CSVD, potentially enhancing clinical decision-making and patient outcomes.
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Affiliation(s)
- Ning Li
- Department of Neurology, Hebei Medical University, Shijiazhuang, China
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, China
| | - Ying-lei Li
- Department of Neurology, Hebei Medical University, Shijiazhuang, China
- Department of Emergency Medicine, Baoding First Central Hospital, Baoding, China
| | - Li-tao Li
- Department of Neurology, Hebei Medical University, Shijiazhuang, China
- Department of Neurology, Hebei General Hospital, Shijiazhuang, China
- Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Hebei General Hospital, Shijiazhuang, China
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Hou Y, Qin W, Yang S, Li Y, Yang L, Hu W. Diffusion-weighted Imaging Detection of Acute Ischemia Brain Lesions in Spontaneous Intracerebral Hemorrhage Associated with White Matter Hyperintensities, Enlarged Perivascular Spaces and Diabetes Mellitus. Curr Neurovasc Res 2024; 20:544-552. [PMID: 38288839 DOI: 10.2174/0115672026283323240108052711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 07/16/2024]
Abstract
OBJECTIVE Diffusion-weighted imaging (DWI) is commonly detected after spontaneous intracerebral hemorrhage (sICH) and is associated with poor functional outcomes. However, the etiology and significance of DWI lesions remain unclear. Thus, our study aimed to explore the prevalence and risk factors of acute ischemic lesions in sICH and discussed the possible mechanisms. METHODS We conducted a retrospective review of a consecutive cohort of 408 patients from June 2013 to October 2019 with sICH, who had brain computed tomography (CT) and magnetic resonance imaging (MRI) within 14 days of symptoms onset. Acute ischemic lesions were assessed on MRI using DWI lesions. We compared the clinical and imaging characteristics of patients with and without DWI lesions. The data were analyzed by univariate and multivariate logistic regression. RESULTS Among the enrolled 408 patients, the mean age was 56.8 ± 14.5 years, 68 (16.7%) of them had been diagnosed with diabetes mellitus (DM). DWI lesions were observed in 89 (21.8%) patients, and most of them had a history of lacunar infarctions, which were located in cortical or subcortical. In multivariate logistic regression analysis, DM (odds ratio (OR) 3.962, p <0.001), severe deep white matter hypertensities (DWMH) (OR 2.463, p =0.001) and severe centrum semiovale enlarged perivascular spaces (CSO-EPVS) (OR 2.679, p =0.001) were independently associated with the presence of DWI lesions. CONCLUSION In our cohort, we found DM, severe DWMH and severe CSO-EPVS were the independent risk factors in sICH patients with DWI lesions.
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Affiliation(s)
- Yutong Hou
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Wei Qin
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shuna Yang
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yue Li
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Lei Yang
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Wenli Hu
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Ran Q, Tian H, Lin J, Wang H, Wang B, Chen Z, Song D, Gong C. Mesenchymal Stem Cell-Derived Exosomes: A Novel Approach to Diabetes-Associated Cognitive Impairment. J Inflamm Res 2023; 16:4213-4228. [PMID: 37753267 PMCID: PMC10519429 DOI: 10.2147/jir.s429532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
The progression of diabetes frequently results in a myriad of neurological disorders, including ischemic stroke, depression, blood-brain barrier impairment, and cognitive dysfunction. Notably, diabetes-associated cognitive impairment, a prevalent comorbidity during the course of diabetes, progressively affects patients' cognitive abilities and may reciprocally influence diabetes management, thereby severely impacting patients' quality of life. Extracellular vesicles, particularly nanoscale exosomes, have garnered considerable attention in recent years. These exosomes carry and transfer various functional molecules, such as proteins, lipids, and diverse non-coding RNAs, serving as novel regulators and communicators in intercellular interactions. Of particular interest, mesenchymal stem cell-derived exosomes (MSC-Exos) have been reported to traverse the blood-brain barrier and ameliorate intracerebral pathologies. This review elucidates the role of MSC-Exos in diabetes-related cognitive impairment, with a focus on their applications as biomarkers, modulation of neuronal regeneration and synaptic plasticity, anti-inflammatory properties, antioxidative effects, and their involvement in regulating the functionality of β-amyloid proteins during the course of cognitive impairment. The immense therapeutic potential of MSC-Exos in the treatment of diabetes-induced cognitive dysfunction is emphasized.
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Affiliation(s)
- Qingsen Ran
- Department of Science and Education, Shenzhen Pingle Orthopedic Hospital (Shenzhen Pingshan Traditional Chinese Medicine Hospital), Shenzhen, Guangzhou Province, 518118, People’s Republic of China
| | - He Tian
- Department of Science and Education, Shenzhen Pingle Orthopedic Hospital (Shenzhen Pingshan Traditional Chinese Medicine Hospital), Shenzhen, Guangzhou Province, 518118, People’s Republic of China
| | - Jian Lin
- Department of Science and Education, Shenzhen Pingle Orthopedic Hospital (Shenzhen Pingshan Traditional Chinese Medicine Hospital), Shenzhen, Guangzhou Province, 518118, People’s Republic of China
| | - Han Wang
- Department of Gastroenterology, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin Province, 130021, People’s Republic of China
| | - Bo Wang
- Department of Science and Education, Shenzhen Pingle Orthopedic Hospital (Shenzhen Pingshan Traditional Chinese Medicine Hospital), Shenzhen, Guangzhou Province, 518118, People’s Republic of China
| | - Zhixin Chen
- Department of Science and Education, Shenzhen Pingle Orthopedic Hospital (Shenzhen Pingshan Traditional Chinese Medicine Hospital), Shenzhen, Guangzhou Province, 518118, People’s Republic of China
| | - Da Song
- Department of Science and Education, Shenzhen Pingle Orthopedic Hospital (Shenzhen Pingshan Traditional Chinese Medicine Hospital), Shenzhen, Guangzhou Province, 518118, People’s Republic of China
| | - Chunzhu Gong
- Department of Science and Education, Shenzhen Pingle Orthopedic Hospital (Shenzhen Pingshan Traditional Chinese Medicine Hospital), Shenzhen, Guangzhou Province, 518118, People’s Republic of China
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Ruksakulpiwat S, Benjasirisan C, Ding K, Phianhasin L, Thorngthip S, Ajibade AD, Thampakkul J, Zhang AY, Voss JG. Utilizing Social Determinants of Health Model to Understand Barriers to Medication Adherence in Patients with Ischemic Stroke: A Systematic Review. Patient Prefer Adherence 2023; 17:2161-2174. [PMID: 37667687 PMCID: PMC10475305 DOI: 10.2147/ppa.s420059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/11/2023] [Indexed: 09/06/2023] Open
Abstract
Introduction Ischemic strokes and their recurrence create an immense disease burden globally. Therefore, preventing recurrent strokes by promoting medication adherence is crucial to reduce morbidity and mortality. In addition, understanding the barriers to medication adherence related to the social determinants of health (SDoH) could promote equity among persons with ischemic stroke. Objective To explore the barriers to medication adherence among patients with ischemic stroke through the SDoH. Methods This systematic review included studies published between January 2018 and December 2022 identified through PubMed, MEDLINE, Web of Science, and CINAHL Plus Full Text. The descriptions of the studies were systematically summarized and discussed based on the SDoH from the US Healthy People 2030 initiative. Results Eight studies met the inclusion criteria and were included in this review. The most common barrier to adherence was inappropriate medication beliefs, medication side effects, and patient-physician relationship, which relate to the dimensions of healthcare access and quality. Health literacy and health perception, dependent on education access and quality, frequently influenced adherence. Other social determinants, such as financial strain and social and community context, were found to alter adherence behaviors. No study addressed the neighborhood and built environment domain. We found that cognitive impairment is another factor that impacts adherence outcomes among stroke patients. Conclusion Multifaceted approaches are needed to address the SDoH to improve medication adherence among patients with ischemic stroke. This review emphasized strategies, including patient education, provider-patient communication, social support, health literacy, technology, and policy advocacy to enhance adherence.
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Affiliation(s)
- Suebsarn Ruksakulpiwat
- Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | | | - Kedong Ding
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Lalipat Phianhasin
- Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Sutthinee Thorngthip
- Department of Nursing Siriraj Hospital, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Anuoluwapo D Ajibade
- College of Art and Science, Department of Anthropology, Case Western Reserve University, Cleveland, OH, USA
| | - Jai Thampakkul
- Case School of Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Amy Y Zhang
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Joachim G Voss
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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Kongwatcharapong J, Sornkhamphan A, Kaveeta C, Nathisuwan S. Validation and comparison of the stroke prognosis instrument (SPI-II) and the essen stroke risk score (ESRS) in predicting stroke recurrence in Asian population. BMC Neurol 2023; 23:287. [PMID: 37528418 PMCID: PMC10391888 DOI: 10.1186/s12883-023-03329-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 07/12/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Currently, there are limited data on the accuracy of available risk scores to predict stroke recurrence in the Asian population. METHOD A single-center, retrospective cohort study was conducted among patients with acute ischemic stroke during January 2014 - December 2018. Longitudinal data with three years of follow-up among these patients were collected and validated through both electronic and manual chart review. The area under the receiver-operating curve (AUROC) method or C-statistic and calibration plot were used to evaluate and compare the Stroke Prognosis Instrument II (SPI-II) and the Essen Stroke Risk Score (ESRS) in predicting the long-term risk of recurrent ischemic stroke. The predictive performances of the two scores were compared using DeLong's method. RESULTS The study cohort consisted of 543 patients, including 181 and 362 patients with and without recurrent events. There were no significant differences in mean age and gender between the two groups. Recurrence cases tended to have significant more risk factors compared to those without events. Among cases with recurrent events, 134 (74.03%) and 65.74% (119) cases were classified as high-risk based on SPI-II and ESRS, respectively. The AUROC curve of the SPI-II and ESRS score was 0.646 (95% CI, 0.594-0.697) and 0.614 (95%CI, 0.563-0.665), respectively (p = 0.394). Based on the calibration plot, the SPI-II and ESRS scores showed similar moderate predictive performance on recurrence stroke with a C statistic (95% CI) of 0.655 (95% CI: 0.603-0.707) and 0.631 (95% CI 0.579-0.684), respectively. CONCLUSION Both ESRS and SPI-II scores had moderate predictive performance in Thai population.
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Affiliation(s)
- Junporn Kongwatcharapong
- Pharmaceutical Care in Inpatient unit, Department of Pharmacy, Siriraj Hospital, Bangkok, Thailand
| | - Akaporn Sornkhamphan
- Pharmaceutical Care in Inpatient unit, Department of Pharmacy, Siriraj Hospital, Bangkok, Thailand
| | - Chitapa Kaveeta
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Surakit Nathisuwan
- Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayutthaya Road, Ratchathewi, Bangkok, 10400, Thailand.
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Lacunar Syndromes, Lacunar Infarcts, and Cerebral Small-Vessel Disease. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00027-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Chang JY, Kim WJ, Kwon JH, Lee JS, Kim BJ, Kim JT, Lee J, Cha JK, Kim DH, Cho YJ, Hong KS, Lee SJ, Park JM, Lee BC, Oh MS, Lee SH, Kim C, Kim DE, Lee KB, Park TH, Choi JC, Shin DI, Sohn SI, Hong JH, Bae HJ, Han MK. Association of Prestroke Glycemic Control With Vascular Events During 1-Year Follow-up. Neurology 2021; 97:e1717-e1726. [DOI: 10.1212/wnl.0000000000012729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 08/04/2021] [Indexed: 01/14/2023] Open
Abstract
Background and ObjectivesWe evaluated the association between admission glycated hemoglobin (HbA1c) and subsequent risk of composite vascular events, including stroke, myocardial infarction (MI), and vascular death, in patients with acute ischemic stroke and diabetes.MethodsPatients who had a TIA or an acute ischemic stroke within 7 days of symptom onset and diabetes were included in a retrospective cohort design using the stroke registry of the Clinical Research Center for Stroke in Korea. The association between admission HbA1c and composite vascular events, including stroke, MI, and vascular death, during 1-year follow-up was estimated using the Fine-Gray model. The risk of composite vascular events according to the ischemic stroke subtype was explored using fractional polynomial and linear-quadratic models.ResultsOf the 18,567 patients, 1,437 developed composite vascular events during follow-up. In multivariable analysis using HbA1c as a categorical variable, the risk significantly increased at a threshold of 6.8%–7.0%. The influence of admission HbA1c level on the risk of composite vascular events was pronounced particularly among those in whom fasting glucose at admission was ≤130 mg/dL. The optimal ranges of HbA1c associated with minimal risks for composite vascular events were lowest for the small vessel occlusion subtype (6.6 [95% confidence internal [CI], 6.3–6.9]) compared to the large artery atherosclerosis (7.3 [95% CI, 6.8–7.9]) or the cardioembolic subtype (7.4 [95% CI, 6.3–8.5]).DicussionIn patients with ischemic stroke and diabetes, the risks of composite vascular events were significantly associated with admission HbA1c. The optimal range of admission HbA1c was below 6.8%–7.0% and differed according to the ischemic stroke subtype.
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Bernal M, Escarcena P, Arboix A, Garcia-Eroles L, Vergés E, Díez L, Massons J. Differential Characteristics of Ischemic and Hemorrhagic Stroke in Patients with Cerebral Small Vessel Disease. Neurol India 2021; 69:85-90. [PMID: 33642276 DOI: 10.4103/0028-3886.310106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Small vessel disease (SVD) is the underlying anatomical substrate for both lacunar infarction and subcortical hemorrhage. Aim To assess predictive factors of ischemic or hemorrhagic stroke in patients with cerebral SVD. Materials and Methods Prospective hospital-based stroke registry ("The Sagrat Cor Hospital of Barcelona Stroke Registry") in an acute-care teaching hospital in Barcelona, Spain. From 4597 acute stroke patients included in the stroke registry over a 24-year period, 440 cases of lacunar stroke and 210 of subcortical intracerebral hemorrhage were selected. Demographics, clinical characteristics, risk factors, and early outcome were compared. Predictors of lacuna versus subcortical hemorrhage were assessed by multivariate analyses. Results In a logistic regression model based on demographics, risk factors, clinical features and outcome, dyslipidemia (odds ratio [OR] 2.06 (95% confidence interval (CI) 1.17-3.62) and diabetes (OR 1.97, 95% CI 1.19-3.26) were independent risk factors for lacunar infarction. Anticoagulation therapy (OR 0.05, 95% CI 0.01-0.28), sudden onset (OR 0.51, 95% CI 0.33-0.78), motor symptoms (OR 0.44, 95% CI 0.26-0.76), headache (OR 0.23, 95% CI 0.12-0.41), altered consciousness (OR 0.10, 95% CI 0.05-0.21), respiratory complications (OR 0.19, 95% CI 0.08-0.46), and in-hospital death (OR 0.08, 95% CI 0.02-0.36) were predictors of subcortical hemorrhage. Conclusion Identification of differential clinical and prognostic profile between ischemic and hemorrhagic consequences of underlying cerebral SVD is useful for risk stratification in the current process pursuing precision medicine.
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Affiliation(s)
- Mireia Bernal
- Cerebrovascular Division, Department of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Paula Escarcena
- Cerebrovascular Division, Department of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Adrià Arboix
- Cerebrovascular Division, Department of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Lluis Garcia-Eroles
- Director d'Organització i Sistemes d'Informació, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Catalonia, Spain
| | - Enric Vergés
- Cerebrovascular Division, Department of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Laura Díez
- Cerebrovascular Division, Department of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Joan Massons
- Cerebrovascular Division, Department of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Catalonia, Spain
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Kim JS. Role of Blood Lipid Levels and Lipid-Lowering Therapy in Stroke Patients with Different Levels of Cerebral Artery Diseases: Reconsidering Recent Stroke Guidelines. J Stroke 2021; 23:149-161. [PMID: 34102752 PMCID: PMC8189863 DOI: 10.5853/jos.2021.01249] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/19/2021] [Indexed: 01/13/2023] Open
Abstract
Hyperlipidemia is an important risk factor for ischemic stroke; the Stroke Prevention by Aggressive Reduction in Cholesterol Level and Treat Stroke to Target studies have shown that statins are beneficial for patients with stroke and that a low target for low-density lipoprotein cholesterol (LDL-C) concentration may maximize this benefit. Based on these results, recent guidelines have emphasized the application of "high-intensity statins" and "low LDL-C target" strategies in patients with stroke. However, it should be kept in mind that the role of blood lipids as a risk factor and benefit of lipid-lowering therapy are different among patients with different levels of cerebral arterial diseases. Studies have suggested that hypolipidemia, but not hyperlipidemia, is a risk factor for small vessel diseases (SVDs) such as intracerebral hemorrhages, microbleeds, white matter hyperintensities, and perhaps, lacunar infarction. Although lipid-lowering agents might benefit certain patients with SVD, high-intensity statin and low LDL-C target strategies cannot be applied. In contrast, these strategies are important in patients with extracranial atherosclerosis, such as internal carotid disease, considering ample evidence of the benefits of lipid-lowering agents. Imaging studies have shown that statins stabilize vulnerable plaques in these patients. Although lipid-lowering agents are likely to benefit patients with intracranial atherosclerosis, the degree of their benefit and appropriate target LDL-C level for these patients remain unclear. More studies are needed to elucidate the appropriate lipid-modifying strategies in patients with stroke with different levels of cerebral artery disease.
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Affiliation(s)
- Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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13
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Kwan A, Wei J, Dowling NM, Power MC, Nadareishvili Z. Cognitive Impairment after Lacunar Stroke and the Risk of Recurrent Stroke and Death. Cerebrovasc Dis 2021; 50:383-389. [PMID: 33752211 PMCID: PMC8266725 DOI: 10.1159/000514261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/02/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Patients with poststroke cognitive impairment appear to be at higher risk of recurrent stroke and death. However, whether cognitive impairment after lacunar stroke is associated with recurrent stroke and death remains unclear. We assessed whether global or domain-specific cognitive impairment after lacunar stroke is associated with recurrent stroke and death. METHODS We considered patients from the Secondary Prevention of Small Subcortical Strokes (SPS3) trial with a baseline cognitive exam administered in English by certified SPS3 personnel, 14-180 days after qualifying lacunar stroke. We considered a baseline score of ≤86 on the Cognitive Assessment Screening Instrument to indicate global cognitive impairment, <10 on the Clock Drawing on Command test to indicate executive function impairment, and domain-specific summary scores in the lowest quartile to indicate memory and nonmemory impairment. We used Cox proportional hazards models to estimate the association between poststroke cognitive impairment and subsequent risk of recurrent stroke and death. RESULTS The study included 1,528 participants with a median enrollment time of 62 days after qualifying stroke. During a mean follow-up of 3.9 years, 11.4% of participants had recurrent stroke and 8.2% died. In the fully adjusted models, memory impairment was independently associated with an increased risk of recurrent stroke (hazard ratio, 1.48; 95% confidence interval [95% CI]: 1.04-2.09) and death (hazard ratio, 1.87; 95% CI: 1.25-2.79). Global impairment (hazard ratio, 1.66; 95% CI: 1.06-2.59) and nonmemory impairment (hazard ratio, 1.74; 95% CI: 1.14-2.67) were associated with an increased risk of death. DISCUSSION/CONCLUSION After lacunar stroke, memory impairment was an independent predictor of recurrent stroke and death, while global and nonmemory impairment were associated with death. Cognitive screening in lacunar stroke may help identify populations at higher risk of recurrent stroke and death.
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Affiliation(s)
- Abraham Kwan
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Jingkai Wei
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - N Maritza Dowling
- Department of Acute and Chronic Care, School of Nursing, George Washington University, Washington, District of Columbia, USA
| | - Melinda C Power
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Zurab Nadareishvili
- Department of Neurology, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia, USA,
- Stroke Center, Virginia Hospital Center, Arlington, Virginia, USA,
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14
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Krinock MJ, Singhal NS. Diabetes, stroke, and neuroresilience: looking beyond hyperglycemia. Ann N Y Acad Sci 2021; 1495:78-98. [PMID: 33638222 DOI: 10.1111/nyas.14583] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 12/14/2022]
Abstract
Ischemic stroke is a leading cause of morbidity and mortality among type 2 diabetic patients. Preclinical and translational studies have identified critical pathophysiological mediators of stroke risk, recurrence, and poor outcome in diabetic patients, including endothelial dysfunction and inflammation. Most clinical trials of diabetes and stroke have focused on treating hyperglycemia alone. Pioglitazone has shown promise in secondary stroke prevention for insulin-resistant patients; however, its use is not yet widespread. Additional research into clinical therapies directed at diabetic pathophysiological processes to prevent stroke and improve outcome for diabetic stroke survivors is necessary. Resilience is the process of active adaptation to a stressor. In patients with diabetes, stroke recovery is impaired by insulin resistance, endothelial dysfunction, and inflammation, which impair key neuroresilience pathways maintaining cerebrovascular integrity, resolving poststroke inflammation, stimulating neural plasticity, and preventing neurodegeneration. Our review summarizes the underpinnings of stroke risk in diabetes, the clinical consequences of stroke in diabetic patients, and proposes hypotheses and new avenues of research for therapeutics to stimulate neuroresilience pathways and improve stroke outcome in diabetic patients.
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Affiliation(s)
- Matthew J Krinock
- Department of Neurology, University of California - San Francisco, San Francisco, California
| | - Neel S Singhal
- Department of Neurology, University of California - San Francisco, San Francisco, California
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15
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Imura T, Inoue Y, Tanaka R, Matsuba J, Umayahara Y. Clinical Features for Identifying the Possibility of Toileting Independence after Convalescent Inpatient Rehabilitation in Severe Stroke Patients: A Decision Tree Analysis Based on a Nationwide Japan Rehabilitation Database. J Stroke Cerebrovasc Dis 2021; 30:105483. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/10/2020] [Accepted: 11/14/2020] [Indexed: 01/19/2023] Open
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ARBOIX A, PARRA O, ALIÓ J. Patent foramen ovale closure in non-lacunar cryptogenic ischemic stroke: where are we now? J Geriatr Cardiol 2021; 18:67-74. [PMID: 33613660 PMCID: PMC7868908 DOI: 10.11909/j.issn.1671-5411.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Patent foram ovale (PFO) is the most common anatomical cause of an interarterial shunt. It is usually asymptomatic but may cause paradoxical embolism and is a risk factor for non-lacunar cryptogenic cerebral ischemia in young adults. Although the first clinical trials did not show a significant superiority of PFO closure in the secondary prevention of cerebral ischemia as compared with standard antithrombotic treatment, six subsequent randomized clinical trials (CLOSURE I, PC Trial, RESPECT, CLOSE, REDUCE, and DEFENSE-PFO) performed in a sample of cryptogenic stroke in patients aged 60 years or younger provided evidence of a significant reduction of recurrent cerebral ischemia after percutaneous PFO closure. However, the use of percutaneous PFO closure cannot be generalized to the entire population of patients with cerebral ischemia and PFO, but it is indicated in highly selected patients with non-lacunar cryptogenic cerebral infarction with a large right-to-left shunt, an atrial septal aneurysm and no evidence of atrial fibrillation, as well as in association with antithrombotic treatment for an optimal secondary prevention of cerebral ischemia.
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Affiliation(s)
- Adrià ARBOIX
- Cerebrovascular Division, Department of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Olga PARRA
- Department of Pneumology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Josefina ALIÓ
- Department of Cardiology, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Catalonia, Spain
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17
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Tang R, Liu Z. Relevance of cerebral small vessel disease load scores in first-ever lacunar infarction. Clin Neurol Neurosurg 2020; 200:106368. [PMID: 33260085 DOI: 10.1016/j.clineuro.2020.106368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 10/23/2022]
Abstract
AIM To reveal the correlation between total cerebrovascular disease load and primary lacunar infarction. BACKGROUND Cerebral small vessel disease (CSVD) is the lack of specific clinical manifestations, whose clinical diagnoses are highly dependent on neuroimaging results. Total CSVD load scores may be more suitable for the assessment of overall brain function damage caused by CSVD. Little is known about whether the association between imaging markers of CSVD and CSVD total load scores at the time of first-ever lacunar infarction (LI). METHODS clinical data of 396 patients hospitalised from September 2016 to May 2018 due to a first-ever LI (case group), along with patients diagnosed with CSVD based on imaging alone and those with no abnormalities (control group) based on magnetic resonance imaging (MRI). Binary logistic regression and multiple ordered logistic regression were used to analyse the characteristics of imaging markers of CSVD in patients with first-ever LI, including different total score burden and distribution, and the relationship between different markers. RESULTS In 396 patients, smoking, cholesterol level and total small vessel disease (SVD) score were all significantly associated with the first-ever LI. There were more LI, cerebral microbleeds (CMB), white matter hyperintensities (WMH), and moderate to severe enlarged perivascular spaces (EPVS) in the first-ever LI group, relative to controls (p < 0.01). The Fazekas scores for periventricular WMH, deep WMH, and total Fazekas score were all significantly higher in patients with first-ever LI relative to those with no cerebral abnormalities (p < 0.01). An analysis of various imaging markers of CSVD revealed a significant correlation between the presence and degree of any marker and the severity of other markers, even after adjusting for the presence of other markers (p < 0.05). CONCLUSIONS The first-ever LI group exhibited higher total CSVD score loads, a greater number of lacunae, CMB, severe WMH and moderate to severe EPVS. Smoking is an independent risk factor in patients with first-ever LI.
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Affiliation(s)
- RuoNan Tang
- Department of Neurology, Gaochun Branch of Nanjing Drum Tower Hospital (Gaochun People's Hospital of Nanjing), 53 Maoshan Road, Gaochun District, Nanjing, 211300, China
| | - ZanHua Liu
- Department of Neurology, Gaochun Branch of Nanjing Drum Tower Hospital (Gaochun People's Hospital of Nanjing), 53 Maoshan Road, Gaochun District, Nanjing, 211300, China.
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18
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Zhou Y, Li Q, Zhang R, Zhang W, Yan S, Xu J, Wang S, Zhang M, Lou M. Role of deep medullary veins in pathogenesis of lacunes: Longitudinal observations from the CIRCLE study. J Cereb Blood Flow Metab 2020; 40:1797-1805. [PMID: 31619117 PMCID: PMC7446567 DOI: 10.1177/0271678x19882918] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our purpose is to assess the role of deep medullary veins in pathogenesis of lacunes in patients with cerebral small vessel disease (cSVD). We included patients with baseline and 2.5-year follow-up MRI in CIRCLE study. Susceptibility Weighted Imaging-Phase images were used to evaluate deep medullary veins based on a brain region-based visual score, and T2-Fluid-Attenuated-Inversion-Recovery images were used to evaluate lacunes. Cerebral blood flow and microstructural parameters in white matter hyperintensities and normal appearing white matter were also analyzed. A total of 203 cSVD patients were analyzed and 101 (49.8%) patients had baseline lacunes. Among them, 64 patients had follow-up MRI, including 16 (25.0%) with new lacunes. The patients' deep medullary veins median score was 9 (7-12). At baseline, high deep medullary veins score was independently associated with the presence of lacunes after adjusting for age, diabetes mellitus, white matter hyperintensities volume and cerebral blood flow or white matter microstructural parameters (all p < 0.001). Longitudinally, high deep medullary veins score was independently associated with new lacunes after adjusting for gender (p < 0.001). The association was also independent of white matter hyperintensities volumes, cerebral blood flow or white matter microstructural parameters (all p < 0.05). Our results suggest that deep medullary veins disruption might be involved in pathogenesis of lacunes.
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Affiliation(s)
- Ying Zhou
- Department of Neurology, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Qingqing Li
- Department of Neurology, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Ruiting Zhang
- Department of Neurology, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Wenhua Zhang
- Department of Neurology, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Shenqiang Yan
- Department of Neurology, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Jinjin Xu
- Department of Neurology, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Shuyue Wang
- Department of Radiology, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Min Lou
- Department of Neurology, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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Lv A, Zhang Z, Fu Y, Yan Y, Yang L, Zhu W. Dawson's Fingers in Cerebral Small Vessel Disease. Front Neurol 2020; 11:669. [PMID: 32849175 PMCID: PMC7396560 DOI: 10.3389/fneur.2020.00669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 06/03/2020] [Indexed: 12/12/2022] Open
Abstract
To explore Dawson's fingers in cerebral small vessel disease (CSVD) and factors related to the development of Dawson's finger, we collected and analyzed clinical data of 65 patients with CSVD. We found a venous abnormality feature called Dawson's fingers around the ventricles in magnetic resonance images (MRIs) of 20 out of 65 patients with CSVD (30. 8%). A significant association between Dawson's fingers and diabetes mellitus (DM) was also detected (30 vs. 8.9%, P < 0.05). CSVD patients with Dawson's fingers had significantly increased cerebral microbleeds (CMB) (44.2 vs. 75.0%, p < 0.05), lacunae (66.7 vs. 95.0%, p < 0.05), and white matter hyperintensity (WMH) (p < 0.05) damage, and these patients exhibited significant cognitive domain impairment as assessed via Montreal Cognitive Assessment (MoCA) (18.9 ± 1.8 vs. 24.0 ± 0.8, p < 0.05) and Mini-Mental State Examination (MMSE) (24.5 ± 1.1 vs. 26.6 ± 0.6, p < 0.05). Our results show a distinctly high incidence of Dawson's fingers in CSVD patients and identify a significant association with DM, thus yielding insights about the appropriate use of Dawson's fingers, a venous imaging marker, to explore the basic pathophysiology of CSVD.
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Affiliation(s)
- Aowei Lv
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Zaiqiang Zhang
- Department of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying Fu
- Central Laboratory, Department of Neurology and Institute of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yaping Yan
- Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry, National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China, College of Life Sciences, Shaanxi Normal University, Xi'an, China
| | - Li Yang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Wenli Zhu
- Central Laboratory, Department of Neurology and Institute of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Role of antiplatelet therapy in the development of intracranial bleeding after mild traumatic brain injury. Med Clin (Barc) 2020; 154:52-54. [PMID: 30857793 DOI: 10.1016/j.medcli.2019.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVE The use of antiplatelet agents is increasing, mainly in elderly patients in whom cranial trauma is a frequent reason for consultation to the emergency department. In this context, discordances have been described regarding the increased risk of post-traumatic injury that involves taking antiplatelet drugs. Therefore, the objective of this present study was to analyse factors associated with intracranial bleeding after mild brain trauma. PATIENTS AND METHODS A retrospective study was designed that included all patients who had consulted the emergency department during 2016 because of mild brain trauma (Glasgow coma scale 14-15) and excluded patients under anticoagulant therapy. A logistic regression analysis was performed to analyse the variables associated with intracranial bleeding. RESULTS 566 patients were included in the study. 18% of them were taking antiplatelet drugs. Tomography showed haemorrhagic intracranial damage in 16.1%. Factors associated with intracranial bleeding were: advanced age, Glasgow coma scale < 15, high-energy trauma and antiplatelet therapy. DISCUSSION Antiplatelet therapy emerges as a risk factor for intracranial bleeding after mild head trauma, in addition to other known factors.
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21
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Obata K, Kinoshita M, Sato K, Chin M, Yamagata S, Ikeda A, Shindo K. Branch atheromatous disease has a stronger association with late-onset epileptic seizures than lacunar infarction in Japanese patients. J Int Med Res 2020; 48:300060519831572. [PMID: 30841770 PMCID: PMC7140214 DOI: 10.1177/0300060519831572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective To evaluate the relationship between late-onset epileptic seizures and
non-cortical infarction (namely, lacunar infarction and branch atheromatous
disease [BAD]) in Japanese patients. Methods We reviewed the medical records and brain magnetic resonance imaging findings
of all patients with ischemic stroke admitted to the Departments of
Neurology, Neurosurgery, and Stroke Unit at Kurashiki Central Hospital from
1 January 2011 to 31 December 2012. Patients with lacunar infarction and BAD
were enrolled; those with cortical and brain stem ischemic lesions were
excluded. We analyzed the clinical features of patients who developed
late-onset epileptic seizures after cerebral infarction. Results Eighty-five patients with lacunar infarction and 99 patients with BAD were
enrolled. Four patients with BAD subsequently developed epileptic seizures
(2.2% of total patients, 4.0% of patients with BAD), whereas no patients
with lacunar infarction developed epileptic seizures. All patients with
epileptic seizures had infarction involving the basal ganglia or thalamus.
Three of them had multiple cerebral microbleeds, and two had dementia. Conclusions Patients with BAD, but not with lacunar infarction, might have a higher risk
of developing epileptic seizures than the general population. Non-cortical
infarctions with involvement of the basal ganglia or thalamus may increase
the risk of subsequent late-onset epileptic seizures.
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Affiliation(s)
- Kaoru Obata
- Department of Neurology, Kurashiki Central Hospital, Okayama, Japan
| | - Masako Kinoshita
- Department of Neurology, Utano National Hospital, National Hospital Organization, Kyoto, Japan
| | - Kazuaki Sato
- Department of Neurology, Kurashiki Central Hospital, Okayama, Japan
| | - Masaki Chin
- Department of Stroke Unit, Kurashiki Central Hospital, Okayama, Japan
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | - Sen Yamagata
- Department of Stroke Unit, Kurashiki Central Hospital, Okayama, Japan
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | - Akio Ikeda
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Katsuro Shindo
- Department of Neurology, Kurashiki Central Hospital, Okayama, Japan
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Duan X, Zhang D, Wang K, Wu J, Zhang X, Zhang B, Gao X. Comparative study of xuesaitong injection and compound salvia miltiorrhizae injection in the treatment of acute cerebral infarction: a meta-analysis. J Int Med Res 2019; 47:5375-5388. [PMID: 31594441 PMCID: PMC6862920 DOI: 10.1177/0300060519879292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective This study was conducted to systematically evaluate the clinical effectiveness of xuesaitong injection (XST) and compound salvia miltiorrhizae injection (CSM) in the treatment of acute cerebral infarction (ACI). Methods We searched several databases for randomized controlled trials (RCTs) using XST and CSM for the treatment of ACI. Two researchers independently selected the RCTs and extracted information. The quality of included RCTs was evaluated, and then data were analyzed using RevMan5.3 and STATA 12.0 software. Results Twenty-three RCTs that enrolled 2101 participants were included in this study. A meta-analysis showed that XST with routine Western medicine (WM) can achieve a better effect than CSM with WM for the total effective rate ( RR = 1.22, 95% CI: 1.18–1.27). In addition, XST combined with WM could improve neurological impairment ( MD = −4.65, 95% CI: −7.85 – −1.44) and hemorheological parameters. XST decreased the whole blood high shear viscosity, whole blood low shear viscosity, plasma viscosity, and plasma fibrinogen. Conclusions For treating ACI, XST combined with WM was more effective than CSM with WM. However, more evidence is needed to support the safety of XST and CSM.
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Affiliation(s)
- Xiaojiao Duan
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Dan Zhang
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Kaihuan Wang
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Jiarui Wu
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaomeng Zhang
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Bing Zhang
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoyan Gao
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
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Magnetic resonance imaging and risk factors for progression of lacunar infarct lesions in Chinese patients. Neuroradiology 2019; 62:161-166. [PMID: 31654100 DOI: 10.1007/s00234-019-02303-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The proportion of acute symptomatic lacunar infarction lesions that undergo cavitation and the factors influencing cavity formation are yet unclear, particularly in the Chinese population. Hence, we investigated changes in the diameter of acute lacunar infarction lesions and identified the risk factors for the progression of these lesions. METHODS A total of 160 patients (mean age 66 years) with acute symptomatic lacunar infarction lesions underwent two magnetic resonance imaging (MRI) examinations: diffusion-weighted imaging (DWI) at onset (lesion diameter < 20 mm) and T2-weighted imaging/fluid-attenuated inversion recovery sequences at follow-up (median follow-up time 389 days). Lacunar infarction lesion progression was categorized as complete cavitation (lacune), partial cavitation, white matter lesion (WML), or disappearance of the lesion. The risk factors for cavity formation were evaluated. RESULTS Upon follow-up MRI, lesions had changed to lacunes in 20 (12.5%) patients, partial cavitation in 23 (14.4%), WMLs in 97 (60.6%), and had disappeared in 20 (12.5%). Lacune formation was related to hypertension (P = 0.026); cavity (lacune and partial cavitation) formation was related to diabetes (P = 0.009) and diameter change (P = 0.015). CONCLUSIONS Approximately a quarter of the acute symptomatic lacunar infarction lesions observed with follow-up MRI were cavitated. Hypertension was negatively associated with lacune formation; diabetes and diameter change were negatively associated with cavity formation.
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Li F, Chen QX, Chen Y, Wang G, Peng B, Yao T. Prevalence and risk factors of microalbuminuria in patients with lacunar infarction. Postgrad Med 2019; 131:342-347. [PMID: 31032695 DOI: 10.1080/00325481.2019.1613119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objectives: To investigate the prevalence and risk factors for microalbuminuria in patients with lacunar infarction. Methods: 702 lacunar infarction patients and 234 controls were recruited in this study, the concentration of urinary albumin and clinical characteristics were collected for each participant. We analyzed the prevalence of microalbuminuria in lacunar infarction patients, as well as the risk factors of microalbuminuria in patients with lacunar infarction. Results: The prevalence of microalbuminuria in patients with lacunar infarction was 32.8%, which was significantly higher than that in controls (9.8%, P<0.001). Multiple linear regression analysis indicated that age, alcohol abuse, fasting blood glucose, systolic blood pressure, and triglyceride were positively associated with albumin/creatinine ratio levels. Multiple logistic regression analysis indicated that age (odds ratio [OR] = 1.067, 95% confidence interval [CI] = 1.029 to 1.105), alcohol abuse (OR = 3.001, 95% CI = 1.668 to 5.398), fasting blood glucose (OR = 2.014, 95% CI = 1.794 to 2.260), and systolic blood pressure (OR = 1.033, 95% CI = 1.010 to 1.056) were the independent risk factors for microalbuminuria in acute lacunar infarction patients, with high sensitivity, specificity, positive predictive value, and negative predictive value. Receiver operating characteristic curve analysis showed that the area under the curve for age, systolic blood pressure, and fasting blood glucose were 0.618 (cutoff value, 63.5 years; sensitivity, 54.8%; and specificity, 62.9%), 0.736 (cutoff level, 149.5 mmHg; sensitivity, 78.3%; and specificity, 61.2%) and 0.893 (cutoff value, 7 mmol/L; sensitivity, 92.2%; and specificity, 86%), respectively. Conclusion: Lacunar infarction was associated with higher microalbuminuria prevalence. Age, alcohol abuse, fasting blood glucose, and systolic blood pressure were individually significant and correlated factors of microalbuminuria in patients with lacunar infarction. More attention should be provided to this group of patients.
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Affiliation(s)
- Fei Li
- a Department of Neurosurgery , Renmin Hospital of Wuhan University , Wuhan , Hubei , China
| | - Qian-Xue Chen
- a Department of Neurosurgery , Renmin Hospital of Wuhan University , Wuhan , Hubei , China
| | - Yan Chen
- b Department of Neurology , Renmin Hospital of Wuhan University , Wuhan , Hubei , China
| | - Guan Wang
- b Department of Neurology , Renmin Hospital of Wuhan University , Wuhan , Hubei , China
| | - Bo Peng
- b Department of Neurology , Renmin Hospital of Wuhan University , Wuhan , Hubei , China
| | - Tao Yao
- b Department of Neurology , Renmin Hospital of Wuhan University , Wuhan , Hubei , China
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Cui Q, Naikoo NA. Modifiable and non-modifiable risk factors in ischemic stroke: a meta-analysis. Afr Health Sci 2019; 19:2121-2129. [PMID: 31656496 PMCID: PMC6794552 DOI: 10.4314/ahs.v19i2.36] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Stroke is a heterogeneous, multifactorial disease regulated by modifiable and non-modifiable risk factors like total cholesterol, triglycerides, high density lipid-cholesterol (HDL-C), low density lipid-cholesterol (LDL-C) and glucose and non-modifiable factors like age. Evaluation of these risk factors for ischemic stroke may contribute to more effective prevention. Methods This meta-analysis investigated the data up to 2018 with respect to age, total cholesterol, triglycerides, high density lipid-cholesterol (HDL-C), low density lipid-cholesterol (LDL-C) and glucose levels in the Ischemic stroke patients and controls. Data from each eligible study was extracted such as year of publication, first author name, ethnicity/country, number of ischemic stroke patients and healthy controls and studies were subjected to heterogeneity analysis. Results Meta-analysis of the modifiable and non-modifiable risk factors like total cholesterol, HDL-C and LDL-C glucose, triglycerides levels and age were not having significantly associated with ischemic stroke (p>0.05). However meta-analysis of triglyceride yielded significant association ischemic stroke with overall 95% CI (−0.62- (−0.09) and P= 0.007 and glucose also showed significant association with ischemic stroke with 95% CI (-1.08- (−0.14), P=0.01. Studies were subjected to heterogeneity which revealed significant heterogeneity with (P<0.00) and I2>96%. Conclusion Meta-analysis revealed that levels of triglyceride and glucose are the predisposing factors for ischemic stroke in the Asian population.
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Affiliation(s)
| | - Niyaz Ahmad Naikoo
- Xingping people's hospital, No.15 jincheng road, xingping city, shaanxi province. China, 713100
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Zhu R, Liu X, He Z. Association of miR-122, miR-124 miR-126 and miR-143 gene polymorphisms with ischemic stroke in the northern Chinese Han population. Int J Neurosci 2019; 129:916-922. [PMID: 30895838 DOI: 10.1080/00207454.2019.1593979] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Ruixia Zhu
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xu Liu
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhiyi He
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, China
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Kong T, Chen J, Sun K, Zhang W, Wang J, Song L, Wang D, Hui R. Aspirin reduced recurrent stroke risk in patients with lacunar stroke. Acta Neurol Scand 2019; 140:78-83. [PMID: 31002173 DOI: 10.1111/ane.13105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Tao Kong
- Fuwai Hospital, National Center for Cardiovascular Disease Chinese Academy of Medical Science and Peking Union Medical College Beijing China
| | - Jingzhou Chen
- Fuwai Hospital, National Center for Cardiovascular Disease Chinese Academy of Medical Science and Peking Union Medical College Beijing China
| | - Kai Sun
- Fuwai Hospital, National Center for Cardiovascular Disease Chinese Academy of Medical Science and Peking Union Medical College Beijing China
| | - Weili Zhang
- Fuwai Hospital, National Center for Cardiovascular Disease Chinese Academy of Medical Science and Peking Union Medical College Beijing China
| | - Jizheng Wang
- Fuwai Hospital, National Center for Cardiovascular Disease Chinese Academy of Medical Science and Peking Union Medical College Beijing China
| | - Lei Song
- Fuwai Hospital, National Center for Cardiovascular Disease Chinese Academy of Medical Science and Peking Union Medical College Beijing China
| | - Daowen Wang
- Department of Internal Medicine, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Rutai Hui
- Fuwai Hospital, National Center for Cardiovascular Disease Chinese Academy of Medical Science and Peking Union Medical College Beijing China
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Primary involvement of neurovascular coupling in cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy. J Neurol 2019; 266:1782-1788. [PMID: 31028544 DOI: 10.1007/s00415-019-09331-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 04/14/2019] [Accepted: 04/21/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most frequent monogenic cause of cerebral ischemia, but reliable biomarkers to monitor the disease are lacking. AIMS AND OBJECTIVES To evaluate cerebral autoregulation (CA), vasoreactivity (VR), and neurovascular coupling (NVC) in CADASIL patients through a battery of dynamic transcranial Doppler tests. METHODS We screened our database for all pre-dementia CADASIL cases. We monitored cerebral blood flow velocity (CBFV) with transcranial Doppler, blood pressure, and expiratory carbon dioxide (CO2) non-invasively. CA was assessed by transfer function from the spontaneous oscillations of blood pressure to CBFV, VR with inhalation of CO2 at 5%, and hyperventilation and NVC by the CBFV response to visual stimulation. RESULTS We included 27 CADASIL patients and 20 healthy controls with similar age and sexes. CA and VR were similar between groups. However, NVC was significantly affected in CADASIL patients, with lower magnitudes of CBFV upsurge (overshoot 19 ± 5 vs 26 ± 6%, p = 0.013; gain 12 ± 7 vs 17 ± 5%, p = 0.003) and altered time behavior during visual stimulation (natural frequency 0.18 ± 0.06 vs 0.24 ± 0.06 Hz, p = 0.005; rate time 0.7 ± 1.7 vs 2.7 ± 3.5 s, p = 0.025). CONCLUSION Our results express a primary and selective involvement of the neurovascular unit in CADASIL rather than a generalized cerebral vasomotor disturbance. Functional cerebrovascular testing could be useful in patient evaluation and monitoring.
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Yu L, Yang L, Zhang X, Yuan J, Li Y, Yang S, Gu H, Hu W, Gao S. Age and recurrent stroke are related to the severity of white matter hyperintensities in lacunar infarction patients with diabetes. Clin Interv Aging 2018; 13:2487-2494. [PMID: 30584289 PMCID: PMC6290865 DOI: 10.2147/cia.s184463] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background and purpose White matter hyperintensities (WMH) is identified as a marker of cerebral small vessel diseases and is a major contributor to cognitive impairment, depression, gait disturbance, and urinary incontinence. However, the risk factors for WMH in patients with type 2 diabetes mellitus (T2DM) has not been well explored. Thus, in this study, we aimed to investigate the relationship between the severity of WMH and vascular risk factors in lacunar infarction patients with T2DM. Methods Consecutive lacunar infarction patients with T2DM were recruited in this cross-sectional study. Paraventricular WMH (P-WMH) and deep WMH (D-WMH) were separately scored by the Fazekas scale, and classified into two categories by the severity. Vascular risk factors and clinical features were compared between the mild and severe WMH. Multiple logistic regression analysis was used to determine the relationship between severity of WMH and vascular risk factors. Results A total of 327 participants aged 34–91 years were enrolled in this study. Compared with the patients with mild P-WMH, the patients with severe P-WMH had higher age (P=0.031), higher proportion of hypertension (P=0.042) and stroke (P<0.001). Levels of TG, LDL, and HbA1c were significantly higher in patients with mild P-WMH. Compared with the patients with mild D-WMH the patients with severe D-WMH had higher age and hyperhomocysteinemia (HCY) level (P<0.001), higher proportion of hyperlipidemia (P=0.008), and stroke (P<0.001). Multivariable logistic regression analyses showed that higher age and recurrent stroke were independently related to severe P-WMH and D-WMH in lacunar infarction patients with T2DM. Conclusions Age and recurrent stroke are related to the severity of P-WMH and D-WMH in lacunar infarction patients with T2DM.
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Affiliation(s)
- Ling Yu
- Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China,
| | - Lei Yang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China,
| | - Xiaoyu Zhang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China,
| | - Junliang Yuan
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China,
| | - Yue Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China,
| | - Shuna Yang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China,
| | - Hua Gu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China,
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China,
| | - Shan Gao
- Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China,
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Harris S, Sungkar S, Rasyid A, Kurniawan M, Mesiano T, Hidayat R. TOAST Subtypes of Ischemic Stroke and Its Risk Factors: A Hospital-Based Study at Cipto Mangunkusumo Hospital, Indonesia. Stroke Res Treat 2018; 2018:9589831. [PMID: 30534355 PMCID: PMC6252221 DOI: 10.1155/2018/9589831] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/25/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Stroke is a leading cause of death and disability, with ischemic stroke as the highest prevalent cases in Indonesia. Ischemic stroke can be classified further into five subtypes according to TOAST classification. Numerous studies have revealed that stroke risk factor has variable correlation with different stroke subtype. Currently, there is no data regarding this phenomenon in Indonesia. The aim of study is to identify characteristic of ischemic stroke subtypes and the risk factors in TOAST classification. METHODS A retrospective, cross-sectional study of patients diagnosed with ischemic stroke at Cipto Mangunkusumo Hospital from January till December 2016. Demographic data, ischemic stroke subtypes, risk factors, and other relevant data were documented. Bivariate and multivariate analysis was done using SPSS 23. RESULTS 235 recorded data patients were included. Large artery atherosclerosis (LAA) was the most prevalent stroke subtypes at 59,6%, followed with small vessel disease (SVD) at 26,7%, undetermined etiology at 9,8%, cardioembolism (CE) at 2,1%, and other determined etiology at 0,9%. Hypertension was the most common vascular risk factor. However, it was only significant in SVD (p=0,023) and undetermined etiology subtypes (p<0,001). Significant risk factor in LAA was diabetes (55%; p=0,016) while in CE subtypes was atrial fibrillation (60%;p<0,001). In multivariate analyses, hypertension (OR 3; 95% CI 1,12-8,05) was the only variable that was related to SVD while in CE it was atrial fibrillation (OR 113,5; 95% CI 13,6-946,5). CONCLUSION LAA was the most common stroke ischemic subtypes. Associated risk factor in LAA was diabetes while in SVD and undetermined etiology subtypes it was hypertension. Atrial fibrillation was associated with cardioembolism.
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Affiliation(s)
- Salim Harris
- Division of Neurovascular-Neurosonology-Neurointervention, Department of Neurology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Saleha Sungkar
- Department of Parasitology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Al Rasyid
- Division of Neurovascular-Neurosonology-Neurointervention, Department of Neurology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Mohammad Kurniawan
- Division of Neurovascular-Neurosonology-Neurointervention, Department of Neurology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Taufik Mesiano
- Division of Neurovascular-Neurosonology-Neurointervention, Department of Neurology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Rakhmad Hidayat
- Division of Neurovascular-Neurosonology-Neurointervention, Department of Neurology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Chen X, Wang J, Shan Y, Cai W, Liu S, Hu M, Liao S, Huang X, Zhang B, Wang Y, Lu Z. Cerebral small vessel disease: neuroimaging markers and clinical implication. J Neurol 2018; 266:2347-2362. [PMID: 30291424 DOI: 10.1007/s00415-018-9077-3] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 12/28/2022]
Abstract
Cerebral small vessel disease (CSVD) is a broad category of cerebrovascular diseases which primarily affect the perforating arterioles, capillaries and venules with multiple distinct etiologies. In spite of distinctive pathogenesis, CSVD shares similar neuroimaging markers, including recent small subcortical infarct, lacune of presumed vascular origin, white matter hyperintensity of presumed vascular origin, perivascular space and cerebral microbleeds. The radiological features of neuroimaging markers are indicative for etiological analysis. Furthermore, in sporadic arteriosclerotic pathogenesis associated CSVD, the total CSVD burden is a significant predictor for stroke events, global cognitive impairment, psychiatric disorders and later life quality. This review aims to summarize the radiological characteristics as well as the clinical implication of CSVD markers and neuroimaging interpretation for CSVD symptomatology.
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Affiliation(s)
- Xiaodong Chen
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Jihui Wang
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, No.600 Tian He Road, Guangzhou, 510630, Guangdong, China
| | - Yilong Shan
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Wei Cai
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Sanxin Liu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Mengyan Hu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Siyuan Liao
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Xuehong Huang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Bingjun Zhang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Yuge Wang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Zhengqi Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China.
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Arboix A, Parra O. Hypertension and small vessel disease: A dangerous association for cognitive impairment over time. J Clin Hypertens (Greenwich) 2018; 20:1266-1267. [DOI: 10.1111/jch.13360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Adrià Arboix
- Cerebrovascular Division; Department of Neurology; Hospital Universitari del Sagrat Cor; Universitat de Barcelona; Barcelona Catalonia Spain
| | - Olga Parra
- Department of Pneumology; Hospital Universitari del Sagrat Cor; Universitat de Barcelona; Barcelona Catalonia Spain
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Arboix A. Hypertension and the acute phase of intracerebral haemorrhage: more evidence of the 'silent killer'. Eur J Neurol 2018; 25:1007-1008. [PMID: 29603497 DOI: 10.1111/ene.13640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A Arboix
- Cerebrovascular Division, Department of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Catalonia, Spain
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Pan Y, Jing J, Wang Y, Liu L, Wang Y, He Y. Association of hemoglobin glycation index with outcomes of acute ischemic stroke in type 2 diabetic patients. Neurol Res 2018; 40:573-580. [PMID: 29560815 DOI: 10.1080/01616412.2018.1453991] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective This study aimed to investigate the association between the hemoglobin glycation index (HGI) and the prognosis of diabetic patients with ischemic stroke. Methods Data were derived from the Abnormal Glucose Regulation in Patients with Acute Stroke across China (ACROSS-China) registry. Diabetic patients with ischemic stroke were included. HGI was calculated by subtracting the predicted HbA1c based on fasting plasma glucose from the observed HbA1c, and then classified into three groups by the tertiles: low HGI (<-0.62), moderate HGI (-0.62 to 0.35) and high HGI (≥0.36). Outcomes included stroke recurrence, all-cause death and poor outcome at 12 months. Results A total of 976 diabetic patients were included. Low HGI was associated with an increased risk of stroke recurrence and poor outcome (adj.hazard ratio 1.53, 95% confidence intervals (CIs) 1.11-2.12, p = 0.01; and adj.odds ratio 1.64, 95% CI 1.13-2.38, p = 0.01, respectively), and high HGI was associated with an increased risk of poor outcome (adj.odds ratio 1.54, 95% CI 1.06-2.24, p = 0.02), compared with moderate HGI. We found a U-shaped association between HGI and the prognosis. Conclusion Both low HGI and high HGI was associated with an increased risk of poor prognosis in diabetic patients with ischemic stroke, compared with moderate HGI.
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Affiliation(s)
- Yuesong Pan
- a Department of Epidemiology and Health Statistics , School of Public Health, Capital Medical University , Beijing , China.,b Beijing Municipal Key Laboratory of Clinical Epidemiology , Beijing , China.,c Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China
| | - Jing Jing
- c Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.,d China National Clinical Research Center for Neurological Diseases , Beijing , China.,e Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,f Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China
| | - Yongjun Wang
- c Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.,d China National Clinical Research Center for Neurological Diseases , Beijing , China.,e Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,f Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China
| | - Liping Liu
- c Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.,d China National Clinical Research Center for Neurological Diseases , Beijing , China.,e Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,f Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China
| | - Yilong Wang
- c Department of Neurology , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.,d China National Clinical Research Center for Neurological Diseases , Beijing , China.,e Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,f Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China
| | - Yan He
- a Department of Epidemiology and Health Statistics , School of Public Health, Capital Medical University , Beijing , China.,b Beijing Municipal Key Laboratory of Clinical Epidemiology , Beijing , China
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Zhang L, Wu Y, Qiu L, Liu Y, Li Q. Elevated Levels of Serum β2-Glycoprotein I/Oxidized Low-Density Lipoprotein Complexes Are Associated with Cerebral Infarction in Patients with Type 2 Diabetes Mellitus. Med Sci Monit 2018; 24:1232-1240. [PMID: 29489742 PMCID: PMC5841189 DOI: 10.12659/msm.907078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background To determine whether the levels of β2-glycoprotein I (β2-GPI)/oxidized low-density lipoprotein (oxLDL) complexes are correlated with cerebral infarction in patients with type 2 diabetes mellitus (T2DM). Material/Methods The levels of β2-GPI/oxLDL complexes, oxLDL, routine lipid/lipoprotein parameters, oxidative stress molecules, and inflammatory factors were measured in 78 healthy controls, 82 diabetics without cerebral infarction, and 79 diabetics with cerebral infarction. Correlation, multiple linear regression, and logistic regression analyses were performed. Results Serum β2-GPI/oxLDL complexes and oxLDL levels were significantly elevated in cerebral infarction in patients with T2DM (β2-GPI/oxLDL: 1.09±0.16 U/mL; oxLDL: 47.83±8.17 mmol/L) compared with T2DM without cerebral infarction (β2-GPI/oxLDL: 0.95±0.13 U/mL; oxLDL: 41.24±7.12 mmol/L) and healthy controls (β2-GPI/oxLDL: 0.81±0.12 U/mL; oxLDL: 27.97±4.57 mmol/L). The levels of β2-GPI/oxLDL complex in lacunar infarction (1.16±0.15 U/ml) were significantly higher than atherothrombotic infarction (1.07±0.19 U/ml) and cardioembolic infarction (1.00±0.23 U/ml). In all patients with T2DM, the β2-GPI/oxLDL levels were positively correlated with total cholesterol (r=0.474, p=0.001) and triglycerides (r=0.431, p=0.003). oxLDL levels were positively correlated with total cholesterol (r=0.445, p=0.002). The logistic regression analysis indicated that elevated β2-GPI/oxLDL and oxLDL levels were independently associated with diabetic cerebral infarction. Conclusions Elevated levels of serum β2-GPI/oxLDL complexes are associated with cerebral infarction in patients with T2DM, especially in those with lacunar infarction.
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Affiliation(s)
- Limei Zhang
- Department of Endocrinology, Second Affiliated Hospital of Harbin Medical University Heilongjiang, Harbin, Heilongjiang, China (mainland)
| | - Yanhui Wu
- Department of Endocrinology, Second Affiliated Hospital of Harbin Medical University Heilongjiang, Harbin, Heilongjiang, China (mainland)
| | - Lili Qiu
- Department of Endocrinology, Second Affiliated Hospital of Harbin Medical University Heilongjiang, Harbin, Heilongjiang, China (mainland)
| | - Yanhong Liu
- Department of Clinical Laboratory Medicine, Second Affiliated Hospital of Harbin Medical University Heilongjiang, Harbin, Heilongjiang, China (mainland)
| | - Qiang Li
- Department of Endocrinology, Second Affiliated Hospital of Harbin Medical University Heilongjiang, Harbin, Heilongjiang, China (mainland)
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Xu D, Ren Z, Shi J, Wang G, Qin Y, Zhang J, Chen C, Tang W. Preliminary findings on the expression of plasma CD63, CD62P, and PAI 1 in patients with acute cerebral infarction. EUR J INFLAMM 2018. [DOI: 10.1177/2058739218819674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To investigate the expression and clinical significance of lysosomal granule glycoprotein 63 (CD63), P-selectin (CD62P) and endothelial cell plasminogen activator inhibitor (PAI-1) in patients with acute cerebral infarction. A total of 106 patients with acute cerebral infarction (ACI) admitted to our hospital from January to July in 2017 were selected as the patient group; 80 healthy subjects for physical examination in our hospital were selected as the control group. The expression levels of serum CD63, CD62P, and PAI-1 of the subjects were detected. The levels of CD63, CD62P, and PAI-1 in the serum of the patient group were significantly higher than those in the control group. There was a positive correlation between serum CD63 and CD62P (r = 0.672, P < 0.05) in the patient group. There was a positive correlation between serum CD63 and PAI-1 (r = 0.643, P < 0.05) in the patient group. There was also a positive correlation between serum CD62P and PAI-1 (r = 0.601, P < 0.05) in the patient group. Moreover, in other subtypes of cerebral infarction, the expression of CD63, CD62P, and PAI-1 was significantly higher than that of lacunar infarction. CD63, CD62P, and PAI-1 are highly expressed in peripheral blood mononuclear cells (PBMC) and serum of patients with ACI, which may be closely related to the occurrence and development of patients with ACI. These indices may be used as indicators of clinical diagnosis and prognosis in patients with ACI.
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Affiliation(s)
- Donghua Xu
- Department of Neurology, The People’s Hospital of Yixing City, Yixing, China
| | - Zhanyun Ren
- Department of Neurology, The People’s Hospital of Yixing City, Yixing, China
| | - Junfeng Shi
- Department of Neurology, The People’s Hospital of Yixing City, Yixing, China
| | - Guoxiang Wang
- Department of Neurology, The People’s Hospital of Yixing City, Yixing, China
| | - Yaxin Qin
- Department of Neurology, The People’s Hospital of Yixing City, Yixing, China
| | - Jin Zhang
- Department of Neurology, The People’s Hospital of Yixing City, Yixing, China
| | - Chengfang Chen
- Department of Neurology, The People’s Hospital of Yixing City, Yixing, China
| | - Wuzhuang Tang
- Department of Neurology, The People’s Hospital of Yixing City, Yixing, China
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Schaan BD, de Figueiredo Neto JA, Moreira LB, Ledur P, Mattos LAP, Magnoni D, Precoma DB, Machado CA, da Silva Brasileiro AL, Pena FM, Harzheim E, Montenegro S, Bernardez-Pereira S, Damiani LP, Consolim-Colombo FM, de Paola AAV, Andrade J, Guimarães JI, Berwanger O. Diabetes and cardiovascular events in high-risk patients: Insights from a multicenter registry in a middle-income country. Diabetes Res Clin Pract 2017; 127:275-284. [PMID: 28412543 DOI: 10.1016/j.diabres.2017.03.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/08/2017] [Accepted: 03/20/2017] [Indexed: 11/25/2022]
Abstract
AIMS The aim of this study was to determine the rate of major clinical events and its determinants in patients with previous cardiovascular event or not, and with or without diabetes from a middle-income country. METHODS REACT study is a multicenter registry conducted between July 2010 and May 2013 in Brazil. Patients were eligible if they were over 45years old and high cardiovascular risk. Patients were followed for 12months; data were collected regarding adherence to evidence-based therapies and occurrence of clinical events (all-cause mortality, non-fatal cardiac arrest, myocardial infarction, or stroke). RESULTS A total of 5006 subjects was included and analyzed in four groups: No diabetes and no previous cardiovascular event, n=430; diabetes and no previous cardiovascular event, n=1138; no diabetes and previous cardiovascular event, n=1747; and diabetes and previous cardiovascular event, n=1691. Major clinical events in one-year follow-up occurred in 332 patients. A previous cardiovascular event was associated with a higher risk of having another event in the follow-up (HR 2.31 95% CI 1.74-3.05, p<0.001), as did the presence of diabetes (HR 1.28 95% CI 1.10-1.73, p=0.005). In patients with diabetes,failure to reach HbA1c targetswas related topoorer event-free survival compared to patients with good metabolic control (HR 1.70 95% CI 1.01-2.84, p=0.044). CONCLUSIONS In Brazil, diabetes confers high risk for major clinical events, but this condition is not equivalent to having a previous cardiovascular event. Moreover, not so strict targets for HbA1c in patients with diabetes and previous cardiovascular events might be considered.
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Affiliation(s)
- Beatriz D Schaan
- Endocrine Division, Hospital de Clínicas de Porto Alegre/Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | | | | | - Priscila Ledur
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | | | | | | | - Erno Harzheim
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | | | - Lucas P Damiani
- Research Institute of Heart Hospital (Hcor), São Paulo, Brazil
| | - Fernanda M Consolim-Colombo
- Brazilian Society of Cardiology, Brazil; Heart Institute of University of São Paulo, Brazil; Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | | | - Jadelson Andrade
- Brazilian Society of Cardiology, Brazil; Hospital da Bahia, Bahia, Brazil
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Arboix A, Martí L, Dorison S, Sánchez MJ. Bayés syndrome and acute cardioembolic ischemic stroke. World J Clin Cases 2017; 5:93-101. [PMID: 28352633 PMCID: PMC5352964 DOI: 10.12998/wjcc.v5.i3.93] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/10/2016] [Accepted: 12/09/2016] [Indexed: 02/05/2023] Open
Abstract
Bayés syndrome is an under-recognized clinical condition characterized by advanced interatrial block. Bayés syndrome is a subclinical disease that manifests electrocardiographically as a prolonged P wave duration > 120 ms with biphasic morphology ± in the inferior leads. The clinical relevance of Bayés syndrome lies in the fact that is a clear arrhythmological syndrome and has a strong association with supraventricular arrhythmias, particularly atypical atrial flutter and atrial fibrillation. Likewise, Bayés syndrome has been recently identified as a novel risk factor for non-lacunar cardioembolic ischemic stroke and vascular dementia. Advanced interatrial block can be a risk for embolic stroke due to its known sequelae of left atrial dilation, left atrial electromechanical dysfunction or atrial tachyarrhythmia (paroxysmal or persistent atrial fibrillation), conditions predisposing to thromboembolism. Bayés syndrome may be responsible for some of the unexplained ischemic strokes and shall be considered and investigated as a possible cause for cryptogenetic stroke. In summary, Bayés syndrome is a poorly recognized cardiac rhythm disorder with important cardiologic and neurologic implications.
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Kloppenborg RP, Nederkoorn PJ, Grool AM, De Cocker LJL, Mali WPTM, van der Graaf Y, Geerlings MI. Do Lacunar Infarcts Have Different Aetiologies? Risk Factor Profiles of Lacunar Infarcts in Deep White Matter and Basal Ganglia: The Second Manifestations of ARTerial Disease-Magnetic Resonance Study. Cerebrovasc Dis 2017; 43:161-168. [PMID: 28142144 DOI: 10.1159/000454782] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 11/08/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Evidence suggests that lacunar infarcts have different etiologies, possibly related to their anatomical location and vascular territory. We investigated the risk factor profiles of patients with new lacunar infarcts in the basal ganglia and deep white matter. METHODS Within the Second Manifestations of ARTerial disease-Magnetic Resonance study, a prospective cohort on brain changes on MRI in patients with symptomatic atherosclerotic disease, 679 patients (57 ± 9 years) had vascular screening and MRI at baseline and after a mean follow-up of 3.9 years. We investigated the association between vascular risk factors at baseline and appearance of new lacunar infarcts in the basal ganglia and deep white matter at follow-up. RESULTS New lacunar infarcts appeared in 44 patients in the basal ganglia and in 37 patients in the deep white matter. In multivariable analysis, older age, history of cerebrovascular disease, and baseline white matter hyperintensity (WMH) volume were associated with increased risk of new lacunar infarcts in both locations. Hyperhomocysteinemia was associated with increased risk of lacunar infarcts in the basal ganglia (relative risk [RR] 2.0; 95% CI 1.0-4.2), whereas carotid stenosis >70% (RR 2.5; 95% CI 1.2-5.0), smoking (per 10 pack-year: RR 1.1; 95% CI 1.0-1.3), hypertension (RR 3.4; 95% CI 1.2-9.7), and progression of WMH volume (RR 2.4; 95% CI 1.1-5.2) were associated with increased risk of lacunar infarcts in the deep white matter. CONCLUSIONS The different risk factor profiles for new lacunar infarcts in basal ganglia and deep white matter indicate different etiologies. The independent association between progression of WMH and new deep white matter lacunar infarcts suggest a common etiology for these radiological abnormalities.
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Affiliation(s)
- Raoul P Kloppenborg
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
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Associations between the Brief Memory and Executive Test (BMET), Activities of Daily Living, and Quality of Life in Patients with Cerebral Small Vessel Disease. J Int Neuropsychol Soc 2016; 22:561-9. [PMID: 27048925 DOI: 10.1017/s1355617716000187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES In addition to neuropsychological difficulties, patients with cerebral small vessel disease (SVD) can have reduced activities of daily living and a poorer quality of life compared to healthy adults. The Brief Memory and Executive Test (BMET), is a cognitive screening tool designed to be sensitive to the neuropsychological profile of patients with SVD. While the BMET is sensitive to the cognitive consequences of SVD, it is unclear how well scores on this measure relate to functional outcomes. The aims of this study are to investigate the relationship between scores on the BMET and functional outcomes (activities of daily living and quality of life) in SVD, and to compare this with other commonly used cognitive screening tools. METHODS This study included 184 participants with SVD (mean age=63.2; SD=9.9) and 299 healthy controls (mean age=62.4; SD=13.8) who were tested using the BMET, Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), Stroke Specific - Quality of Life Scale (SS-QoL), Geriatric Depression Scale (GDS), and measures of both instrumental activities of daily living (IADL) and basic activities of daily living (BADL). RESULTS After controlling for covariates the scores on the BMET, but not the MoCA or MMSE, were significantly related to poorer IADL and quality of life in the SVD group. In addition to the BMET scores, symptoms of depression were found to be significant associated with functional outcome. CONCLUSION These results support the clinical utility of using of the BMET, in combination with a standardized depression questionnaire, during the early assessment of patients with SVD.
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Norrving B. Lacunar Syndromes, Lacunar Infarcts, and Cerebral Small-vessel Disease. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00027-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Zhou YT, Wang GS, Chen XD, Yang TH, Tong DM. Transient and persistent symptoms in patients with lacunar infarction: results from a prospective cohort study. J Multidiscip Healthc 2015; 8:511-7. [PMID: 26648735 PMCID: PMC4664498 DOI: 10.2147/jmdh.s95175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The transient symptoms with lacunar infarction (TSI) and persistent symptoms with lacunar infarction (PSI) are the most common forms of symptomatic lacunar infarction (LI). The aim of this study was to compare the differences in TSI and PSI of symptomatic LI. Methods A prospective cohort study was conducted in the neurologic outpatients of the tertiary teaching hospital in Northern China between February 2011 and February 2012. The TSI and PSI in participants aged 35 years or over were assessed. Patients were followed up and their outcomes were compared. Results Of the 453 symptomatic outpatients, 251 patients with LI were diagnosed by magnetic resonance imaging. Approximately 77.3% (194/251) of the patients with LI at this time had TSI. and the remaining 23.7% had PSI. After the adjusted odds ratios, only middle age (risk ratio [RR], 1.1; 95% confidence interval [CI], 1.157–1.189), lower National Institutes of Health Stroke Scale score (RR, 20.6; 95% CI, 6.705–13.31), smaller lacunae on brain images (RR, 2.9; 95% CI, 1.960–4.245), and LI frequently in the anterior circulation territory (RR, 0.2; 95% CI, 0.079–0.721) were independently associated with TSI. During a mean follow-up of 6 months, survival rate was significantly higher among patients with TSI than among those with PSI (log rank, 6.9; P=0.010); estimated unadjusted incidence of vascular subsequent events (30.9% vs 54.4%, P=0.001) was significantly lower in TSI than in PSI. Conclusion The TSI has a higher prevalence and is associated with a lower risk of vascular subsequent events and death than PSI. The implications of these findings for TSI and PSI may require different interventions.
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Affiliation(s)
- Ye-Ting Zhou
- Department of Clinical Research, XuZhou Medical University, Jiangsu, People's Republic of China
| | - Guang-Sheng Wang
- Department of Neurology, Affiliated Shuyang People' Hospital, XuZhou Medical University, Jiangsu, People's Republic of China
| | - Xiao-Dong Chen
- Department of Neurology, Affiliated Shuyang People' Hospital, XuZhou Medical University, Jiangsu, People's Republic of China
| | - Tong-Hui Yang
- Department of Neurology, Affiliated Shuyang People' Hospital, XuZhou Medical University, Jiangsu, People's Republic of China
| | - Dao-Ming Tong
- Department of Neurology, Affiliated Shuyang People' Hospital, XuZhou Medical University, Jiangsu, People's Republic of China ; Department of Neurology, the Affiliated Pingxiang Hospital, Southern Medical University, Pingxiang, People's Republic of China
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Delgado M, Corte J, Sáiz A, Calleja S. Recurrent lacunar ischaemic stroke due to resistance to antiplatelet treatment: examining the need for personalised antithrombotic therapy. NEUROLOGÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.nrleng.2013.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Delgado M, Corte J, Sáiz A, Calleja S. Ictus lacunar recurrente por resistencia al tratamiento antiagregante plaquetario: hacia la necesidad de una terapia antitrombótica individualizada. Neurologia 2015; 30:376-8. [DOI: 10.1016/j.nrl.2013.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/22/2013] [Accepted: 09/10/2013] [Indexed: 11/16/2022] Open
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Arboix A. Cardiovascular risk factors for acute stroke: Risk profiles in the different subtypes of ischemic stroke. World J Clin Cases 2015; 3:418-429. [PMID: 25984516 PMCID: PMC4419105 DOI: 10.12998/wjcc.v3.i5.418] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 01/14/2015] [Accepted: 02/12/2015] [Indexed: 02/05/2023] Open
Abstract
Timely diagnosis and control of cardiovascular risk factors is a priority objective for adequate primary and secondary prevention of acute stroke. Hypertension, atrial fibrillation and diabetes mellitus are the most common risk factors for acute cerebrovascular events, although novel risk factors, such as sleep-disordered breathing, inflammatory markers or carotid intima-media thickness have been identified. However, the cardiovascular risk factors profile differs according to the different subtypes of ischemic stroke. Atrial fibrillation and ischemic heart disease are more frequent in patients with cardioembolic infarction, hypertension and diabetes in patients with lacunar stroke, and vascular peripheral disease, hypertension, diabetes, previous transient ischemic attack and chronic obstructive pulmonary disease in patients with atherothrombotic infarction. This review aims to present updated data on risk factors for acute ischemic stroke as well as to describe the usefulness of new and emerging vascular risk factors in stroke patients.
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Brookes RL, Hollocks MJ, Khan U, Morris RG, Markus HS. The Brief Memory and Executive Test (BMET) for detecting vascular cognitive impairment in small vessel disease: a validation study. BMC Med 2015; 13:51. [PMID: 25858350 PMCID: PMC4372040 DOI: 10.1186/s12916-015-0290-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cognitive impairment is common in patients with cerebral small vessel disease, but is not well detected using common cognitive screening tests which have been primarily devised for cortical dementias. We developed the Brief Memory and Executive Test (BMET); a rapid screening measure sensitive to the impaired executive function and processing speed characteristic of small vessel disease (SVD). To assess the BMET's validity for general use, we evaluated it when administered by non-psychologists in a multicentre study and collected control data to derive normative scores. METHODS Two-hundred participants with SVD, defined as a clinical lacunar stroke and a corresponding lacunar infarct on MRI, and 303 healthy controls aged between 40-90 years old were recruited. The BMET, as well as the Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE), were performed. Overall, 55 SVD participants underwent repeat testing at 3 months to assess the BMET test-retest reliability. RESULTS Administering the BMET took a mean (SD) of 12.9 (4.7) in cases and 9.5 (2.6) minutes in controls. Receiver Operator Curve analysis showed the BMET was a good predictor of cognitive impairment in SVD (AUC = 0.94) and performed significantly better than both the MoCA (AUC = 0.77) and the MMSE (AUC = 0.70). Using a cut-off score of 13, the BMET had a sensitivity of 93% and specificity of 76% for detecting cognitive impairment in SVD. CONCLUSIONS The BMET is a brief and sensitive tool for the detection of cognitive impairment in patients with SVD.
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Gui Q, Yang Y, Ying S, Zhang M. Xueshuantong improves cerebral blood perfusion in elderly patients with lacunar infarction. Neural Regen Res 2014; 8:792-801. [PMID: 25206726 PMCID: PMC4146085 DOI: 10.3969/j.issn.1673-5374.2013.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 02/25/2013] [Indexed: 11/18/2022] Open
Abstract
A total of 64 patients with acute lacunar infarction were enrolled within 24 hours of onset. The patients received conventional therapy (antiplatelet drugs and hypolipidemic drugs) alone or conventional therapy plus 450 mg Xueshuantong once a day. The main ingredient of the Xueshuantong lyophilized powder used for injection was Panax notoginseng saponins. Assessments were made at admission and at discharge using the National Institutes of Health Stroke Scale, the Activity of Daily Living and the Mini-Mental State Examination. Additionally, the relative cerebral blood flow, relative cerebral blood volume and relative mean transit time in the region of interest were calculated within 24 hours after the onset of lacunar infarction, using dynamic susceptibility contrast magnetic resonance perfusion imaging technology. Patients underwent a follow-up MRI scan after 4 weeks of treatment. There was an improvement in the Activity of Daily Living scores and a greater reduction in the scores on the National Institutes of Health Stroke Scale in the treatment group than in the control group. However, the Mini-Mental State Examination scores showed no significant differences after 4 weeks of treatment. Compared with the control group, the relative cerebral blood flow at discharge had increased and showed a greater improvement in the treatment group. Furthermore, there was a reduction in the relative mean transit time at discharge and the value was lower in the treatment group than in the control group. The experimental findings indicate that Xueshuantong treatment improves neurological deficits in elderly patients with lacunar infarction, and the mechanism may be related to increased cerebral perfusion.
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Affiliation(s)
- Qifeng Gui
- Department of Geriatrics, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Yunmei Yang
- Department of Geriatrics, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Shihong Ying
- Department of Radiology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Minming Zhang
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
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Hart RG, Pearce LA, Bakheet MF, Benavente OR, Conwit RA, McClure LA, Talbert RL, Anderson DC. Predictors of stroke recurrence in patients with recent lacunar stroke and response to interventions according to risk status: secondary prevention of small subcortical strokes trial. J Stroke Cerebrovasc Dis 2014; 23:618-24. [PMID: 23800503 PMCID: PMC3858405 DOI: 10.1016/j.jstrokecerebrovasdis.2013.05.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 05/14/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Among participants in the Secondary Prevention of Small Subcortical Strokes randomized trial, we sought to identify patients with high versus low rates of recurrent ischemic stroke and to assess effects of aggressive blood pressure control and dual antiplatelet therapy according to risk status. METHODS Multivariable analyses of 3020 participants with recent magnetic resonance imaging-defined lacunar strokes followed for a mean of 3.7 years with 243 recurrent ischemic strokes. RESULTS Prior symptomatic lacunar stroke or transient ischemic attack (TIA) (hazard ratio [HR] 2.2, 95% confidence interval [CI] 1.6, 2.9), diabetes (HR 2.0, 95% CI 1.5, 2.5), black race (HR 1.7, 95% CI 1.3, 2.3), and male sex (HR 1.5, 95% CI 1.1, 1.9) were each independently predictive of recurrent ischemic stroke. Recurrent ischemic stroke occurred at a rate of 4.3% per year (95% CI 3.4, 5.5) in patients with prior symptomatic lacunar stroke or TIA (15% of the cohort), 3.1% per year (95% CI 2.6, 3.9) in those with more than 1 of the other 3 risk factors (27% of the cohort), and 1.3% per year (95% CI 1.0, 1.7) in those with 0-1 risk factors (58% of the cohort). There were no significant interactions between treatment effects and stroke risk status. CONCLUSIONS In this large, carefully followed cohort of patients with recent lacunar stroke and aggressive blood pressure management, prior symptomatic lacunar ischemia, diabetes, black race, and male sex independently predicted ischemic stroke recurrence. The effects of blood pressure targets and dual antiplatelet therapy were similar across the spectrum of independent risk factors and recurrence risk.
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Affiliation(s)
- Robert G Hart
- Department of Medicine (Neurology), McMaster University, Hamilton, Ontario, Canada.
| | | | - Majid F Bakheet
- Department of Neurology, Taiba University, Medina, Saudi Arabia
| | - Oscar R Benavente
- Department of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robin A Conwit
- National Institute of Neurological Disorders and Stroke, Rockville, Maryland
| | - Leslie A McClure
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert L Talbert
- Department of Clinical Pharmacy, University of Texas, Austin, Texas
| | - David C Anderson
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota
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Variants of COL3A1 are associated with the risk of stroke recurrence and prognosis in the Chinese population: a prospective study. J Mol Neurosci 2014; 53:196-203. [PMID: 24664438 DOI: 10.1007/s12031-014-0283-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 03/04/2014] [Indexed: 01/19/2023]
Abstract
Type III collagen plays an important role in activating platelets, forming thrombus, and maintaining the mechanical properties of arteries. This study aimed to test the hypothesis that genetic variants of COL3A1 (gene encoding type III collagen) contribute to recurrence and prognosis of stroke. We investigated the associations of three variants (rs2138533, rs11887092, and rs1800255) in the COL3A1 gene with stroke recurrence and prognosis in 1,544 patients with three subtypes of stroke: lacunar infarction (n = 442), atherothrombotic infarction (n = 670), and hemorrhage (n = 432). These associations were evaluated by Kaplan-Meier analysis and Cox regression models. Patients were followed up for 4.5 years. The A allele of rs1800255 in the COL3A1 gene coding region was significantly associated with a reduced risk of stroke recurrence in patients with lacunar infarction (adjusted hazard ratio [HR] 0.58, 95 % confidence interval [CI] 0.36-0.93, P = 0.024), but there was an increased risk of all-cause mortality of atherothrombotic patients (adjusted HR 1.43, 95 % CI 1.01-2.00, P = 0.044). The TT genotype of rs2138533 showed a significantly increased risk of death caused by cardiovascular disease or stroke in lacunar infarct patients (adjusted HR 2.98, 95 % CI 1.27-6.98, P = 0.012), but there was a reduced risk of all-cause mortality for patients with intracerebral hemorrhage (adjusted HR 0.34, 95 % CI 0.12-0.93, P = 0.036). The G allele of rs11887092 increased the risk of stroke recurrence in patients with atherothrombotic stroke (adjusted HR 1.59, 95 % CI 1.04-2.44, P = 0.035). In conclusion, variants of COL3A1 might play a vital role in determining the risk of recurrence and prognosis after stroke.
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Arboix A, Blanco-Rojas L, Martí-Vilalta JL. Advancements in understanding the mechanisms of symptomatic lacunar ischemic stroke: translation of knowledge to prevention strategies. Expert Rev Neurother 2014; 14:261-76. [PMID: 24490992 DOI: 10.1586/14737175.2014.884926] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Symptomatic lacunar ischemic stroke (25% of all brain infarctions) results from occlusion of a single penetrating artery by microatheromas or lipohyalinosis and rarely from an intracranial atheromatous branch disease. Recurrent lacunar stroke may be associated with more severe clinical features and has been involved in producing lacunar state and vascular subcortical dementia. In the first multicenter randomized clinical trial (SPS3) focused on stroke prevention among patients with recent lacunar stroke, the addition of clopidogrel to aspirin not only did not reduced significantly the risk of recurrent stroke, but also increased significantly the likelihood of hemorrhage and fatal outcome. If lacunar stroke is primarily non-atherothromboembolic, secondary prevention aimed at preventing atheroma progression may not be very effective. The efficacy of drugs that improve endothelial function in lacunar stroke patients remains to be studied in the future.
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Affiliation(s)
- Adrià Arboix
- Department of Neurology, Cerebrovascular Division, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, C/Viladomat 288, E-08029 Barcelona, Catalonia, Spain
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