Recurrent Transient Ischemic Attacks Revealing Cerebral Amyloid Angiopathy: A Comprehensive Case

This case report investigates the manifestation of cerebral amyloid angiopathy (CAA) through recurrent Transient Ischemic Attacks (TIAs) in an 82-year-old patient. Despite initial diagnostic complexities, cerebral angiography-MRI revealed features indicative of CAA. Symptomatic treatment resulted in improvement, but the patient later developed a fatal hematoma. The discussion navigates the intricate therapeutic landscape of repetitive TIAs in the elderly with cardiovascular risk factors, emphasizing the pivotal role of cerebral MRI and meticulous bleeding risk management. The conclusion stresses the importance of incorporating SWI sequences, specifically when suspecting a cardioembolic TIA, as a diagnostic measure to explore and exclude CAA in the differential diagnosis. This case report provides valuable insights into these challenges, highlighting the need to consider CAA in relevant cases.

Transient ischemic attack induced by pulmonary arteriovenous fistula in a child:A case report

BACKGROUND Cerebral ischemic stroke is attributed to paradoxical cerebral embolism.Pulmonary arteriovenous fistula(PAVF)is a rare potential cause of cerebral ischemic stroke,and cerebral ischemic stroke induced by PAVF in children is rare.CASE SUMMARY We report a case of right PAVF that presented as a transient ischemic attack(TIA)in a 13-year-old boy.The patient underwent embolization therapy and remained clinically stable for 2 years after treatment.CONCLUSION TIA induced by PAVF in children is rare,lacks typical clinical manifestations,and should not be ignored.

Diagnostic value of ABCD2 and ABCD3-Ⅰ risk scoring systems in determining one-month risk of stroke in patients with transient ischemic attack: An observational study

Objective:To compare the diagnostic value of the ABCD2 and ABCD3-栺scoring systems in predicting the development of a 30-day neurological event in adult patients with transient ischemic attack(TIA)presenting to the emergency department.Methods:The study was observational and prospective and was conducted in a single center.The diagnostic values of the ABCD2 and ABCD3-栺scores in predicting a neurological event within one month were compared in patients diagnosed with TIA in the emergency department.Results:A statistically significant difference was observed between groups with or without stroke within one month in terms of both the ABCD2 and ABCD3-栺scores(P=0.044 and P=0.029,respectively).There was no statistically significant difference between the patients with and without a recurrent TIA within one month in relation to the ABCD2 score(P=0.934),but a statistically significant difference was found in the ABCD3-栺scores of these groups(P<0.001).Conclusions:Both the ABCD2 and ABCD3-栺scoring systems could predict ischemic stroke within 30 days of TIA,the ABCD3-栺score is more effective than the ABCD2 score in the prediction of TIA recurrence.

Cerebral perfusion in corresponding blood supply areas of transient ischemic attack patients with intracranial stenosis Seven cases of diamox-perfusion verified by magnetic resonance-perfusion-weighted imaging

BACKGROUND： Due to collateral circulation and cerebrovascular reserve, arterial stenosis and reduced cerebral blood flow may not necessarily indicate impaired cerebral peffusion. Therefore, according to degree of stenosis and clinical symptoms, interventional surgery to relieve arterial stenosis in transient ischemic attack （TIA） patients with major intracranial stenosis is imprudent. Rather, cerebral perfusion and reserve capacity are direct indicators for the assessment of degree and presence of cerebral ischemia. OBJECTIVE： To evaluate cerebral perfusion and reserve in TIA patients with major intracranial stenosis or occlusion using magnetic resonance-perfusion-weighted imaging （MR-PWl） data prior to and following diamox administration. DESIGN, TIME AND SETTING： A self-comparative, neuroimaging observation was performed at the Neurological Department and Radiological Center of the First Affiliated Hospital of Jinan University between December 2007 and April 2009. PARTICIPANTS： Seven acute TIA patients, who were admitted to the Neurological Department of the First Affiliated Hospital of Jinan University between December 2007 and April 2009, were enrolled in the present study. Magnetic resonance imaging confirmed that no acute cerebral infarction happened, nor did bleeding exist. Magnetic resonance angiography, transcranial Doppler ultrasound, and/or digital subtraction angiography confirmed the presence of major intracranial arterial stenosis. Clinical symptoms corresponded to blood supplying regions of the arterial stenosis. METHODS： Baseline MR-PWI was performed on seven patients with intracranial stenosis or occlusion. Two grams of acetazolamide （diamox） were orally administered after 2 days. A second PWl was performed after 2 hours to compare cerebral perfusion parameters prior to and following diamox administration. MAIN OUTCOME MEASURES： PWI results of cerebral perfusion prior to and following diamox administration. RESULTS： The baseline PWl from five patients indicated decreased cerebral perfusion areas. Following oral administration of diamox, cerebral perfusion significantly decreased in those areas. Moreover, new areas of decreased cerebral perfusion were observed in two out of the five patients. In one patient, no significant decrease in cerebral perfusion was found. In another patient, baseline PWl indicated decreased cerebral perfusion in the left hemisphere. However, normal perfusion was observed in both cerebral lobes following diamox administration. CONCLUSION： TIA patients with intracranial stenosis, who are diagnosed by PWI and exhibited decreased cerebral perfusion and reserve, might require further treatment such as intervention by angioptasty.

Yizhi Xingnao prescription improves the cognitive function of patients after a transient ischemic attack

Patients with mild cognitive impairment after a transient ischemic attack were included in this study. They were treated with Yizhi Xingnao prescription, ergoloid mesylates or aspirin for 60 days. Evaluation using the Montreal Cognitive Assessment Scale showed that cognitive function was significantly improved in all patients, especially after the combined treatment of Yizhi Xingnao and aspirin. The scores from the Montreal Cognitive Assessment Scale were improved overall and the effective treatment rate was as high as 79%, which was higher than patients treated with a combination of ergoloid mesylates and aspirin, or aspirin alone. Our experimental findings indicate that YizhiXingnao prescription can improve mild cognitive impairment after a transient ischemic attack, and that it is more effective than ergoloid mesylates.

Clinical analysis on neuroprotection of transient ischemic attacks

Transient ischemic attack（TIA） is an acute cerebrovascular incident,and is generally considered the best opportunity for early neuroprotective treatment against cerebral ischemia.This study retrospectively analyzed 80 patients with TIA（38 males and 42 females）.Among 61 patients who received neuroprotective cerebrolysin treatment within 24 hours after TIA onset,13（21.31%） patients suffered subsequent strokes.Among 19 patients who received neuroprotective cerebrolysin treatment within 24-72 hours after TIA onset,seven（36.84%） developed cerebral infarction.There was a significant difference in the proportion of subsequent strokes between patients receiving cerebrolysin treatment within 24 hours and 24-72 hours after TIA onset（P = 0.438）.These findings suggest that neuroprotective drugs administrated within 24 hours after TIA onset help reduce the incidence of subsequent strokes.The results demonstrate usefulness of the ABCD2 score at TIA patients in the determination of short-term and long-term cerebrovascular risk,including the frequency of subsequent ischemic cerebral infarctions up to 12 months.

Executive function during transient ischemic attacks

BACKGROUND： Recent researches demonstrate that damage of executive function is an early manifestation of vascular cognitive disorder. OBJECTIVE： To investigate the executive functions of patients with transient ischemic attack （TIA）. DESIGN： Case control. SETTING： Department of Neurology, the First Affiliated Hospital of Xinxiang Medical College. PARTICIPANTS： A total of 83 TIA patients （46 males and 37 females, aged 32 - 74 years） were selected from Department of Neurology, the First Affiliated Hospital of Xinxiang Medical College from July 2005 to December 2006. The diagnosis of TIA was established by the criteria of cerebrovascular diseases made by the Fourth National Cerebrovascular Disease Meeting. In these cases, forty-five patients （54%） were involved in internal carotid artery, and thirty-eight patients （46%） were involved in vertebral basilar system. Fifty healthy adults （Control group： 28 males and 22 females, aged 32 - 74 years） were chosen from retiree in community and family of patients. All of them were right-handedness, without cerebrovascular disease, cerebral trauma, inborn oligophrenia, and heating and visual disorders; also they had no anxiety and depression nearly one week. In addition, all the subjects cooperated with examination. METHODS： After TIA diagnosis, all patients received neuropsychological examination, including attention and inhibition, working memory, flexibility, planning and diversion, based on Stroop tests （C and CW） and the Wisconsin card sorting tests （WCST）. ① WCST test： The edition revised by Nelson was used. We would take the times of sorting, incorrect response, persistent incorrect response, and randomly incorrect response as the index of evaluation.② Stroop tests： The edition revised by Trenarry was used and this test had two types： form color and form color-word. Their incorrect response and response time were recorded for data analysis in the end. MAIN OUTCOME MEASURES： Results of WCST test and Stroop tests. RESULTS： A total of 83 TIA patients and 50 healthy subjects were involved in the final analysis. Items of Stroop tests, including response time of Stroop-C test, incorrect response of Stroop-C test, response time of Stroop-CW test and incorrect response of Stroop-CW test, and items of WCST, including incorrect response, persistent incorrect response and random incorrect response, between internal carotid artery system and vertebral basilar artery system were （93.87±24.39） s, 3.16±3.97, （228.46±68.13） s, 12.91 ± 10.56, 55.42± 20.38, 26.58± 10.41, 28.62±11.22; （96.76±24.75） s, 3.89±4.77, （223.46±72.54） s, 18.71 ± 13.80, 52.47 ±22.25, 28.82± 16.20, 23.39±9.72, respectively; this was higher than those in the control group [（52.10± 12.18） s, 1.68± 1.97, （134.86±34.15） s, 4.22±4.21, 32.46± 17.97, 14.42±8.47, 18.24± 10.24, P 〈 0.05 - 0.01]. Times of sorting of WCST between internal carotid artery system and vertebral basilar artery system were obviously lower than those in the control group （8.27±2.73, 8.66±2.77, 11.22±2.41, P 〈 0.01）. However, there were no significant differences between internal carotid artery system and vertebral basilar artery system （P 〉 0.05）. CONCLUSION： Patients with TIA have executive dysfunctions, and the dysfunctions have no difference between internal carotid artery system and vertebral basilar artery system.

Radix Ilicis Pubescentis total flavonoids ameliorates neuronal damage and reduces lesion extent in a mouse model of transient ischemic attack

Flavonoids are a major component in the traditional Chinese medicine Radix Ilicis Pubescentis.Previous studies have shown that the administration of Radix Ilicis Pubescentis total flavonoids is protective in cerebral ischemia.However,to our knowledge,no studies have examined whether the total flavonoids extracted from Radix Ilicis Pubescentis prevent or ameliorate neuronal damage following transient ischemic attacks.Therefore,Radix Ilicis Pubescentis total flavonoids question and the potential underlying mechanisms.Thus,beginning 3 days before the induction of a mouse model of transient ischemic attack using tert-butyl hydroperoxide injections,mice were intragastrically administered 0.3,0.15,or 0.075 g/kg of Radix Ilicis Pubescentis total flavonoids daily for 10 days.The results of spectrophotometric analyses demonstrated that Radix Ilicis Pubescentis total flavonoids enhanced oxygen free radical scavenging and reduced pathological alterations in the brain.Hematoxylin-eosin staining results showed that Radix Ilicis Pubescentis total flavonoids reduced hippocampal neuronal damage and cerebral vascular injury in this mouse model of transient ischemic attack.These results suggest that the antioxidant effects of Radix Ilicis Pubescentis total flavonoids alleviate the damage to brain tissue caused by transient ischemic attack.

Magnetic resonance imaging in patients with transient ischemic attack

Transient ischemic attack （TIA） is a temporary event, which portends a higher risk of a disabling stroke following the TIA. However, the evaluation and management of TIA vary worldwide and is debated and controversial. With the development of brain imaging, particularly diffusion weighted imaging-magnetic resonance imaging （DWI-MRI）, the diagnosis of TIA changed from time-based definition to a tissue-based one. DWI-MRI be-came a mandatory tool in the TIA workup. The DWI-MRI provides not only the evidence to distinguish between TIA and acute ischemic stroke, fur-thermore it predicts TIA patients who are at higher risk of disabling stroke, which can be prevented by an immediate evaluation and treatment of TLA.

Transient ischemic attack after mRNA-based COVID-19 vaccination during pregnancy:A case report

BACKGROUND Thrombocytopenia with thrombosis syndrome has been reported after vaccination against severe acute respiratory syndrome coronavirus 2 with two mRNA vaccines.The syndrome is characterized by thrombosis,especially cerebral venous sinus thrombosis,and may lead to stroke.Pregnant women with stroke show higher rates of pregnancy loss and experience serious pregnancy complications.We present the case of a 24-year-old pregnant woman with a transient ischemic attack(TIA) that developed after vaccination with the Moderna mRNA-1273 vaccine(at 37 2/7 wk).CASE SUMMARY TIA occurred 13 d following the coronavirus disease vaccination.At 39 1/7 wk of pregnancy,the patient presented with sudden onset of right eye blurred vision with headache,dizziness with nausea,right-hand weakness,anomia,and alexia.The symptoms lasted 3 h;TIA was diagnosed.Blood test results revealed elevated D-dimer,cholesterol,and triglyceride levels.Brain magnetic resonance imaging showed no acute hemorrhagic or ischemic stroke.At pregnancy 37 6/7 wk,she was admitted for cesarean delivery to reduce subsequent risk of stroke during labor.Body mass index on admission was 19.8 kg/m~2.Magnetic resonance angiography and transesophageal echocardiography showed no abnormalities.The next day,a mature female baby weighing 2895 g and measuring 50 cm was delivered.Apgar scores were 8 and 9 in the first and fifth minutes.D-dimer levels decreased on postoperative day 4.After discharge,the autoimmune panel was within normal limits,including antinuclear and antiphospholipid antibodies.CONCLUSION TIA might be developed after the mRNA vaccines in pregnant women.

Carotid Doppler and transcranial Doppler in diagnosing transient ischemic attack: A healthy control

BACKGROUND： If changes of hemodynamics in internal or external cranial artery and stenosis of atherosclerosis are found eady, patients with transient ischemic attack （TIA） may be treated at an eady phase so as to prevent and decrease the onset of cerebral infarction. Carotid Doppler can analyze carotid canal wall, hemodynamic properties and stenosis, and changes of plaque morphology; however, transcranial Doppler （TCD） can evaluate vascular stenosis and occlusion and judge collateral circulation in cranium through detecting velocity and direction of blood flow. Can the association of them increase the diagnostic rate of TIA？ OB3ECTIVE： To evaluate the effect of the association of carotid Doppler and TCD on TIA in internal carotid artery. DESIGN： Contrast observational study SETTING： Department of Neuroelectrophysiology, Central People＇s Hospital of Huizhou PARTICIPANTS： A total of 54 patients with TIA in internal carotid artery were selected from the Department of Neurology of Huizhou Central People＇s Hospital from May 2004 to June 2005. There were 35 males and 24 females aged 46-81 years. The clinical situation was asthenia of single limb, hemiplegia, anaesthesia of single upper or lower limb, hemianesthesia, sensory disorder and aphasia. The symptoms lasted for less than 2 hours. All cases were diagnosed with CT, and those who had pathological changes of acute cerebral infarction and history of cardiac disease were excluded. Additionally, 50 healthy subjects who were regarded as control group were selected from the Department of Neurology of Huizhou Central People＇s Hospital. There were 30 males and 20 females aged 45-80 years. All subjects were consent. METHODS： HD15000 color Doppler ultrasound （Philips Company, USA） and Muliti-DopX2 TCD （DWL Company, Germany） were used to detect hemodynamics, stenosis and distribution of atherosclerosis in carotid artery and internal carotid artery. Evaluation of marker： Stenosis was calculated by the ratio between the minimal cavity and vascular sectional area at the maximal site of plaque （mild： stenosis 〈 50%; moderate and severe： stenosis t〉 50%）. With TCD, the following results were regarded as stenosis： blood velocity of average envelope 〉 120 cm/s （diagnostic criteria of vascular stenosis of basilar artery： blood velocity of average envelope 〉 80 cm/s）, increase and segmental property of blood flow, and murmu of turbulent flow and vessel. MAIN OUTCOME MEASURES： Positive rate of atherosclerosis and incidence of stenosis with carotid Doppler and TCD. RESULTS： All 54 TIA patients and 50 healthy subjects were involved in the final analysis. ① Results of carotid Doppler： Atherosclerosis and stenosis were obvious in experimental group. Positive rate of atherosclerosis was 85% （46/54） and incidence of stenosis of carotid artery was 41% （22/54）, which were higher than those in control group [52% （26/54）, 41% （22/54）, x^2 = 13.42, 10.90, P 〈 0.01]. ② Results of TCD： In experimental group, positive rate of atherosclerosis at base of skull was 89% （48/54） and incidence of stenosis of internal cranial artery was 48% （26/54）, which were higher than those in control group [62% （31/50）, 0, x^2 = 10.28, 32.00, P 〈 0.01]. Stenosis of artery was mainly involved in middle cerebral artery, initial segment and crotch of carotid artery. CONCLUSION： The association of carotid Doppler and TCD can increase clinically diagnostic rate of TIA and provide bases for apposition and intensity of TIA lesion.

Long-term follow-up study of 72 patients with transient ischemic attacks

Objective To observe the long-term follow-up of 72 patients with transient ischemic attack (TIA) and evaluate the clinical significance of neurovascular surgical indication. Methods Seventy-two patients with TIA collected from years 1959 to 1977 were followed up by means of face-to-face communication with the patients themselves or their families till year 1998. According to the principle of life table, the recurrence of TIA after the first attack, occurrence of complete stroke and myocardial infarction, fatality rate, causes of death and survival rate every year, and the 95% confidence interval were calculated and analyzed.Results Till 1998, the recurrent rate of TIA in 72 patients was 27.9%, the occurrence rate of complete stroke 65.7%, and that of myocardial infarction 8.4%. The fatality rate was 72.7%. Among the deaths, 2 (3.8%) patients died of myocardial infarction. It was shown from the study that the main cause of death was complete stroke, accounting for 59.6% of all deaths, with the main cause in non-elderly patients being cerebral hemorrhage, and that in the elderly patients being cerebral infarction. The 20-year survival rate was 39.9% and its 95% confidence interval was (28.4%, 51.4%). Nineteen cases were indicated for neurovascular surgical operation, accounting for 26.6% of the 72 patients. Conclusions In the long-term follow-up study, about one third of the patients had the recurrent TIA. The occurrence rate of complete stroke was markedly higher than that of myocardial infarction. Presumably, the effect of neurovascular surgical operation on the prevention of complete stroke in patients with TIA is limited.

Association between clinical features and prognosis of patients with limb-shaking transient ischemic attack

Objective This review aims to illustrate the relationship between clinical features and the prognosis of patients with limb-shaking transient ischemic attack （LS-TIA）. Data sources Relevant articles published in two main Chinese medical periodical databases （China National Knowledge Infrastructure and China Science Periodical Database） from 1986 to June 2013 were identified with keywords ＂limb shaking＂ and ＂transient ischemic attack＂. Study selection Original articles and case reports about LS-TIA were selected. Results A total of 63 cases collected from 19 articles were included in the pooled analysis. Ls-rlA presented in two cerebrovascular diseases, of which atherosclerotic high-grade stenosis or occlusion in carotid artery system and moyamoya disease formed 95.2% and 4.8%, respectively. Of 63 patients, 11 （17.5%） were once misdiagnosed as epileptic and prescribed useless antiepilepsy drugs. The multivariable Logistic regression model showed a significant protective effect of patients with revascularization therapy on prognosis, compared with patients treated with drugs （odds ratio 0.20, 95% CI 0.05-0.74, P=0.016）. Conclusions Chronic carotid artery system hypoperfusion can induce limb（s） shaking, followed by high possibility of ischemic stroke in the same brain territorial. Revascularization of the responsible artery may work better than conservative drug-based therapy.

A Longitudinal Functional Magnetic Resonance Imaging Study of Working Memory in Patients Following a Transient Ischemic Attack: A Preliminary Study

In this study, we used functional magnetic resonance imaging(fMRI) to investigate longitudinal changes in brain activation during a verbal working memory(VWM) task performed by patients who had experienced a transient ischemic attack(TIA). Twenty-five first-ever TIA patients without visible lesions in conventional MRI and 25 healthy volunteers were enrolled. VWM task-related fMRI was conducted 1 week and 3 months post-TIA. The brain activity evoked by the task and changes over time were assessed. We found that, compared with controls, patients exhibited an increased activation in the bilateral inferior frontal gyrus(IFG), right dorsolateral prefrontal cortex(DLPFC), insula, inferior parietal lobe(IPL), and cerebellum during the task performed 1 week post-TIA. But only the right IFG still exhibited an increased activation at 3 months post-TIA. A direct comparison of fMRI data between 1 week and 3 months post-TIA showed greater activation in the bilateral middle temporal gyrus, right DLPFC, IPL, cerebellum, and left IFG in patients at 1 week post-TIA. We conclude that brain activity patterns induced by a VWM task remain dynamic for a period of time after a TIA, despite the cessation of clinical symptoms. Normalization of the VWM activation pattern may be progressively achieved after transient episodes of ischemia in TIA patients.

Primary study on imaging in transient ischemic attacks

Background Although transient ischemic attacks （TIA） is a clinical diagnosis, imaging findings are important for its diagnosis and treatment. This study evaluated the value and limitations of conventional CT, CT cerebral perfusion imaging and transcranial Doppler sonography （TCD） in patients with TIA. Methods Conventional CT, CT cerebral perfusion imaging and TCD were performed in 20 patients with TIA. After regular CT examination, d-0-second dynamic scans were performed on selected slice, while 40 ml of nonionic contrast materials was bolus-injected through antecubital vein with power injector. These dynamic images were processed with the perfusion software package on workstation. Cerebral blood flow （CBF） and time to peak （3~FP） were measured in specific regions of the brain. TCD was also performed in 20 patients with TIA. Comparative analysis was made on the basis of the results of conventional CT, CT cerebral perfusion imaging and TCD.Results In the 20 patients with TIA, conventional CT turned out to be normal. However, persisting abnormal perfusion changes corresponding to clinical symptoms were found in 13 cases with the prolonged TFP. The other 7 cases were normal. TFP of the affected side （ 11.6 ± 3.0） s was significantly prolonged （ t =4. 782 ,P 〈0. 01 ） in comparison with the contralateral side （8.8 ± 1.5 ） s. The difference in CBF was not statistically significant （t = 1. 912, P =0. 073） between the affected side [ （223.9 ±19.6） ml ·min^-1 ·L^-1 ] and the contralateral side [ （227.7 ± 19. 8） ml · min^-1· L^-1 ] . TCD revealed severe stenosis or occlusion of the carotid artery in 10 patients, arteriosclerosis in 6 patients, blood speed decrease in 2 patients, vasospasm in 1 patient. Conclusions Conventional CT can exclude intracerebral diseases. Perfusion CT provides valuable hemodynamic information and shows the extent of perfusion disturbances. TCD can demonstrate abnormalities of the involved arteries in patients with TIA. The combination of these three imaging methods can provide more diagnostic information.

Multiple Mild Stimulations Reduce Membrane Distribution of CX3CR1 Promoted by Annexin al in Microglia to Attenuate Excessive Dendritic Spine Pruning and Cognitive Deficits Caused by a Transient Ischemic Attack in Mice

A transient ischemic attack(TIA)can cause reversible and delayed impairment of cognition,but the specific mechanisms arestill unclear.Annexin al(ANXA1)is a phospholipid-binding protein.Here,we confirmed that cognition and hippocampal synapses were impaired in TIA-treated mice,and this could be rescued by multiple mild stimulations(MMS).TIA promoted the interaction of ANXAl and CX3CR1,increased the membrane distribution of CX3CR1 in microglila,and thus enhanced the CX3CR1 and CX3CL1 interaction.These phenomena induced by TIA could be reversed by MMS.Meanwhile,the CX3CR1 membrane distribution and CX3CR1-CX3CL1 interaction were upregulated in primary cultured microglia overexpressing ANXAl,and the spine density was significantly reduced in co-cultured microglia overexpressing ANXAl and neurons.Moreover,ANXAl overexpression in microglia abolished the protection of MMS after TIA.Collectively,our study provides a potential strategy for treating the delayed synaptic injury caused by TIA.

Post-ischemic Elevation of Circulating Hepatocyte Growth Factor Differentiates Stroke from Transient Ischemic Attack

Background:A rapid elevation of post-ischemic circulating hepatocyte growth factor(HGF)levels has been reported in acute vascular disease including stroke.However,the impact of transient ischemic attack(TIA)on circulating HGF has never been studied.Methods:Patients with an onset of either stroke or TIA within the past 30 days were enrolled.Based on the ischemic event,the patients were divided into a stroke group and a TIA group.Blood samples were collected at enrollment and at follow-up visits at one,three,and six months until a recurrent cerebral ischemic event.Plasma levels of HGF were measured using an enzyme-linked immunosorbent assay and logarithmically transformed to eliminate skewness.Results:Thirty-six patients were enrolled in the study,with 20 in the stroke group and 16 in the TIA group.The dynamic HGF levels post-ischemia showed distinct patterns between the two groups.A significant decrease of HGF levels was observed in the stroke group,from 2.62±0.18 ng/mL within 30 days after stroke to 2.41±0.22 ng/mL beyond 30 days(P=0.026);however,no significant change was found in the TIA group(2.22±0.17 ng/mL vs.2.19±0.16 ng/mL,P=0.990).A multivariate regression analysis showed a last event of stroke and a comorbidity of systemic atherosclerotic disease(SAD)were independently associated with higher levels of HGF.Subgroup analyses showed HGF levels decreased from 2.64±0.22 ng/mL within 30 days after stroke to 2.36±0.18 ng/mL beyond 30 days in patients without SAD(P=0.008),but not in patients with SAD(P=0.700).Conclusion:Our data indicate that in patients without SAD,circulating HGF is a potential biomarker to distinguish between stroke and TIA.

Neuroprotective effect of ischemic preconditioning in focal cerebral infarction: relationship with upregulation of vascular endothelial growth factor

Neuroprotection by ischemic preconditioning has been confirmed by many studies, but the precise mechanism remains unclear. In the present study, we performed cerebral ischemic pre- conditioning in rats by simulating a transient ischemic attack twice （each a 20-minute occlusion of the middle cerebral artery） before inducing focal cerebral infarction （2 hour occlusion-reper- fusion in the same artery）. We also explored the mechanism underlying the neuroprotective effect of ischemic preconditioning. Seven days after ocdusion-reperfusion, tetrazolium chloride staining and immunohistochemistry revealed that the infarct volume was significantly smaller in the group that underwent preconditioning than in the model group. Furthermore, vascular endothelial growth factor immunoreactivity was considerably greater in the hippocampal CA3 region of preconditioned rats than model rats. Our results suggest that the protective effects of ischemic preconditioning on focal cerebral infarction are associated with upregulation of vascu- lar endothelial growth factor.

A novel cerebrovascular drug-coated balloon catheter for treating symptomatic intracranial atherosclerotic stenosis lesions:Study protocol for a prospective,multicenter,single-arm,target-value clinical trial

Background:Previous single-center studies have demonstrated that drug-coated balloons(DCBs)may reduce restenosis rates,which is an important factor affecting the prognosis for intracranial interventional therapy.However,currently available cardiac DCBs are not always suitable for the treatment of intracranial atherosclerotic stenosis(ICAS).This study aimed to evaluate the safety and efficacy of a novel DCB catheter designed for patients with severely symptomatic ICAS.Methods:This prospective,multicenter,single-arm,target-value clinical trial was conducted in 9 Chinese stroke centers to evaluate the safety and efficacy of a novel DCB catheter for treating symptomatic severe ICAS.Primary metrics and other indicators were collected and analyzed using SAS version 9.4(SAS Institute,Cary,NC,USA).Results:A total of 155 patients were enrolled in this study.The preliminary collection of follow-up data has been completed,while data quality control is ongoing.Conclusion:Results of this study demonstrated the patency rate,safety,and effectiveness of a novel on-label paclitaxel DCB designed for the treatment of ICAS.Ethics and dissemination:This study,involving human participants,was reviewed and approved by the Ethics Committee of Drugs(Devices)Clinical Experiment at Henan Provincial People’s Hospital(reference number:2020-145-03)and other research centers participating in the clinical trial.The results of this study will be presented at international conferences and sent to peer-reviewed journals for publication.Standard protocol items:The Recommendations for Interventional Trials checklist was used when drafting the study protocol.Trial registration number:Registered with the Chinese Clinical Trial Registry on June 11,2021(Chi CTR2100047223).

Anesthetic and Obstetric Considerations of Moyamoya Disease in Pregnancy after Intracranial Bypass Grafting: A Case Report and Literature Review

Moyamoya disease (MD) is a chronic idiopathic vasculopathy characterized by bilateral stenosis of the distal internal carotid arteries (ICA’s) with subsequent formation of abnormal collateral vessels. The underlying etiology is unknown [1]. Patients with MD are predisposed to intracranial hemorrhage or cerebral ischemia given the fragile nature of the collateral circulation. Although there is no curative treatment for MD, there are surgical palliative procedures that can augment cerebral blood flow to areas of impaired perfusion and circumvent the abnormal collateral circulation. Medical management exists for patients who are not surgical candidates. Because the incidence of MD peaks during the second and third decades of life, it can potentially affect women of childbearing age [2]. However, the optimal anesthetic and obstetric management of the parturient with MD remains controversial. We present a case of a primigravida with a history of MD who underwent intracranial bypass grafting prior to conception and subsequently had a successful cesarean delivery that was complicated by transient ischemic attacks (TIA) in the postpartum period.