Cerebral amyloid angiopathy (CAA) is an age-dependent disease affecting older subjects. CAA is characterized by lobar intracerebral hemorrhage (ICH), lobar cerebral microbleeds (CMBs), nontraumatic subarachnoid hemorrhage, and cortical superficial siderosis (cSS), which is the main causes of spontaneous intracranial hemorrhage in the elderly. If a patient had experienced dementia, psychiatric symptoms, recurrent or multiple lobar hemorrhage, the possibility of CAA should be considered. Epilepsy can be associated with CAA. Literature studies had found that CAA-related inflammation are predisposing factors for the development of epilepsy. It is a unique subtype of CAA, which is a form of inflammation and a rare clinical manifestation of sporadic CAA. CAA-ri is a special type of central nervous system vasculitis. Once CAA patients had exhibited atypical clinical manifestations, such as headache, epilepsy, behavioral changes, focal neurological signs, consciousness impairment combined with asymmetric T2 weighted magnetic resonance imaging high signal lesions, clinicians had to consider it maybe CAA-ri. Although CAA- ri is rare, timely diagnosis is important because once seizure had occured, which may indicated the inflammation in CAA patients may had reached a very serious level. Therefore, timely identification and treatment are particularly important. Literature shows that most patients responded well to immunosuppressants. Because of its uncommon, researches on epilepsy in CAA mainly focused on case reports currently, and there were many controversies about its pathological mechanism, treatment and prognosis. This article mainly reviews the incidence rate , pathological mechanism, treatment and prognosis of epilepsy in CAA.
Cerebral small vessel disease (CSVD) encompasses a group of progressive disorders involving the small vessels of the brain with complex etiologies. Inflammation plays a pivotal role in both the onset and progression of CSVD. In age-related CSVD, chronic inflammation can exacerbate brain tissue damage by impairing endothelial function and disrupting the blood-brain barrier. In contrast, in inflammatory CSVD subtypes driven primarily by immune dysregulation, inflammation itself constitutes the core pathogenic mechanism. These subtypes present with diverse clinical manifestations, posing significant challenges for diagnosis and treatment. A deeper understanding of the inflammatory mechanisms involved in CSVD and the unresolved issues in this field may provide new avenues for personalized interventions and improved prognosis.
Objective To investigate the efficacy and safety of the application of selective cerebral perfusion (SCP) technique in pediatric aortic arch reconstruction, so as to alleviate brain injury during operation. Methods From April 2007 to May 2008, 32 children aged from 8 days to 103 months (14.4±25.4 months) and weighed from 27 kg to 22.0 kg (6.7±4.4 kg) underwent aortic arch reconstruction with selective cerebral perfusion in Shanghai Children’s Medical Center. Twentytwo suffered from aortic coarctationwith intracardiac anomaly, and 10 suffered from interrupted aortic arch with intracardiac anomaly. The arterial cannulation was achieved by placing a flexible wire wound cannula in ascending aorta close to the root part of innominate artery. The rectal temperature was about 1820℃. Then the cannula was moved upward into innominate artery to perform SCP. Results The time of SCP was 17-121 mins（39.6±19.4 mins）, perfusion blood flow maintained in 15-40 ml/(kg·min)［29.7±6.1 ml/(kg·min）］. Four cases died of low cardiac output syndrome or arrhythmia, and no evidence of brain injury was observed. No obvious neurologic complication was observed in 28 survivls. No abnormal electroencephalogram was observed in 25 cases. The results of head Bsonography and brain magnetic resonance image (MRI) were normal in 5 neonates. Conclusion Selective cerebral perfusion is a simple, feasible, safe and effective technique in pediatric aortic arch reconstruction.
Objective To assess the clinical application of lysophosphatidic acid (LPA) as the early warning index for cerebral ischemic stroke (CIS). Methods Trials were collected through electronic searches of PubMed, The Cochrane Library, CBM, CNKI, Wanfang, and VIP (from the date of database establishment to June 2009). We screened the retrieved studies according to the predefined inclusion and exclusion criteria, evaluated the quality of the included studies, performed descriptive analysis and meta-analysis with The Cochrane Collaboration’s RevMan 4.2 software. Results A total of 22 studies were included. The results of meta-analyses showed that, there was a significant difference about LPA level in cerebral infarction (CI) group vs. healthy control group (WMD=2.00, 95%CI 1.85 to 2.15), and in transient ischemia attach (TIA) group vs. healthy control group (WMD=2.48, 95%CI 2.18 to 2.78); and a difference was noted about 24 hours LPA level in CI group vs. healthy control group (WMD=2.40, 95%CI 1.81 to 2.99). Conclusions According to the included studies, the contents of LPA is higher in CIS than that in healthy control group. It would be helpful to measure LPA in the TIA period for intervention. However, more high quality trials are expected for further study, in order to prove the value of LPA as early warning index because of the heterogeneity and poor quality of the current included studies.
Objective To analyze the risk factors of hypertension combined with cerebral hemorrhage. Methods From May 2015 to October 2016, 92 hypertension patients with cerebral hemorrhage (group A) were enrolled; simultaneously, 110 hypertension patients without cerebral hemorrhage (group B) were included. We analyzed retrospectively the clinical data of two groups and the risk factors of hypertension complicated with cerebral hemorrhage. Results The results of univariate analysis showed that the ratios of patients in group A with the following indexes, >65 years old, body mass index >30 kg/m2, >7-year smoking history, triglyceride level >1.7 mmol/L, cholesterol level >5.72 mmol/L, high density lipoprotein level >0.9 mmol/L, and bad medication compiance, were much more higher than those in group B (P<0.05). The rusults of multivariate analysis showed that smoking history, diabetes mellitus history, hypertension history, triglycerides level, cholesterol level, bad medication compliance were the risk factors of hypertension combined with cerebral hemorrhage (P<0.05). Conclusions The risk factors of hypertension combined with cerebral hemorrhage include smoking history, diabetes mellitus history, hypertension history, triglyceride level, cholesterol level, and medication compliance. We shoud pay more attention to these factors in clinical practice.
ObjectiveTo explore the concentration of the plasma homocysteine (Hcy) and the relationship with TOAST subtypes in patients with acute cerebral infarction. MethodsA total of 120 patients with acute cerebral infarction (ACI) treated from April 2012 to April 2013 were enrolled into the ACI group.They were classified with Korean TOAST classification as five subtypes:atherothrombosis (AT) type,small artery disease (SAD) type,cardioembolism (CE) type,stroke of other disease (SOD) type,and stroke of undetermined etiology (SUE) type.The plasma Hcy concentrations in each group and in 60 heathy people who were selected into the control group were measured.Furthermore,the relationship between plasma Hcy concentration and their subtypes were analyzed. ResultsThe plasma Hcy level in ACI group was significant higher than that in the control group (P<0.01).The levels of plasma Hcy were much higher in patients with AT,SAD,SOD,and CE than those in the control groups (P<0.01).In different subtypes,AT and SAD subtypes had higher homocysteine concentration than SUD and CE subtypes did.The concentration of Hcy in AT and SAD group had no significant difference. ConclusionACI is related to hyperhomocysteinemia.The plasma Hcy level varies with different TOAST subtypes of ACI,specially elevating in the subtypes of AT and SAD,which may indicate that hyperhomocysteinemia may increase stroke risk through proatherogenic effect and endothelial dysfunction.
Objective To investigate the relationship between systolic blood pressure (SBP) and etiological subtype in patients with cerebral infarction. Methods Retrospective analysis was made on the data of patients with cerebral infarction admitted to West China Hospital of Sichuan University between January 2015 and March 2018. Patients within 24 h of symptom were included. Etiological subtypes were classified according to Trial of Org 10172 in Acute Stroke Treatment criteria. Multinomial logistic regression was used to analyze the correlation between SBP at admission and etiological subtype. Results A total of 944 eligible cases were included, accounting for 37.3% (944/2528) of the total number of registered cases. The mean age was (65.35±14.17) years, and 57.5% (543/944) were male. The median time from onset to admission was 15 h, with 54.7% (516/944) of patients having elevated blood pressure. Among the patients, large artery atherosclerosis, small artery occlusion, cardiogenic embolism, other definite causes and undetermined causes accounted for 24.9% (235 cases), 21.2% (200 cases), 20.0% (189 cases), 1.8% (17 cases), and 32.1% (303 cases), respectively. Multinomial analysis showed that there was a significant negative correlation between SBP at admission and cardioembolic etiology [odds ratio (OR)=0.987, 95% confidence interval (CI) (0.977, 0.998)]; normal SBP at admission [<140 mm Hg (1 mm Hg=0.133 kPa)] was significantly positively correlated with cardioembolic etiology [OR=2.016, 95%CI (1.211, 3.357)]. Conclusion Normal SBP at admission with acute cerebral infarction predicts cardioembolic etiology, which will be helpful for clinicians to make individual decision based on the pathogenesis in the early stage.
Objective To investigate the feasibility and clinical value of combined treatment for lung cancer with cerebral metastasis. Methods From May 1999 to May 2005, twentyone patients diagnosed lung cancer with cerebral metastasis received treatment in our hospital. The management consists of cerebral lesion resection, chemotherapy, lung cancer resection and chemotherapy or radiotherapy. Then evaluate the short-term and long-term outcome. Results No severe complications occurred in hospital. The 1-, 2-, and 3-year survival rates were 75.0%(12/16), 37.5%(6/16), and 12.5%(2/16) respectively. Life quality was promoted significantly. Conclusion Although lung cancer with cerebral metastasis is classified as stage Ⅳ,the effect of combined treatment is favorable because of the special metastatic position. But the choice of the patient is important.
Purpose To examine the change of optic disc blood flow in primary open angle glaucoma(POAG) patients after cold provocation test and nifedipine administration． Methods Using Heidelberg retinal flowmetry (HRF),the blood flow of optic disc of glaucoma patients and normal control subjects were measured under basal condition, after cold provocation test,and after nifedipine administration. Results The mean optic disc blood volume and flow of POAG patients reduced from 27.1 and 545.4 to 22.3 and 452.4 after cold provocation test (Plt;0.05),and increased to 29.0 and 579.5 after nifedipine adminstration(Plt;0.05).The changes of mean optic disc blood flow of patients with a history of cold extremities show statistic significance compared with whom without such history (Plt;0.05)). Conclusion The changes of blood flow of optic disc in POAG patients may be influenced by cold stimuli and administration of nifedipine,and the history of cold extremities might be connected with the change of optic disc blood flow in POAG patients. (Chin J Ocul Fundus Dis,2000,16:85-87)
Objective To investigate the impact of different modes of cardiopulmonary bypass （CPB） and cerebral perfusion on cerebral protection in patients with Stanford type A aortic dissection （AD）. Methods Clinical data of 117 patients with Stanford type A AD who underwent surgical therapy from April 2007 to March 2012 in the First Affiliated Hospital of Harbin Medical University were retrospectively analyzed. All the patients were divided into 3 groups according to different modes of CPB and cerebral perfusion they received. In group 1，45 patients received CPB perfusion through the femoral artery and unilateral or bilateral antegrade selective cerebral perfusion （ASCP） after circulatory arrest. In group 2，38 patients received CPB perfusion through the subclavian artery or innominate artery and unilateral or bilateral ASCP after circulatory arrest. In group 3，34 patients received antegrade and retrograde CPB perfusion through both subclavian artery or innominate artery and femoral artery，and unilateral or bilateral ASCP after circulatory arrest. Postoperative occurrence of transient neurological dysfunction （TND），permanent neurological dysfunction （PND） and influential factors were compared between the 3 groups. Results Incidence of postoperative cerebral complications of group 1 was significantly higher than those of group 2 and 3 （37.77% vs. 13.16% vs. 14.71%，P ＜0.05）. During CPB，cooling time of group 3 was significantly shorter than those of group 1 and 2 （35.56±4.35 vs. 40.00±5.63 and 39.58±6.03，P ＜0.05）. There was no statisticaldifference in other influential factors among the 3 groups （P ＞0.05）. Conclusion Antegrade and retrograde CPB perfusionin combination with ASCP has a smooth and quicker cooling rate，may provide better protection for the spinal cord，kidney and intraperitoneal organs and especially decrease the incidence of postoperative cerebral complications，therefore is proved current best method for organ protection.