Acute aortic dissection mimicking acute myelopathies: a case report

Myelopathy is a common etiology of acute bilateral limb weakness. While painless acute aortic dissection(AAD)is the most common catastrophic event that can mimic myelopathic manifestations of acute bilateral limb weakness, it is often easily ignoredWe describe a case of painless AAD in a 70-year-old man with a history of hypertension manifesting as acute myelopathy(bilateral limb weakness and loss of all types of sensation)with increased levels of serum myoglobin and D-dimer.Magnetic resonance imaging of the spinal cord revealed a normal thoracic and lumbar spinal cord but a dissection of the thoracic aorta. Computed tomography angiography of the chest and abdominal aorta showed a Stanford type B dissection extending throughout the thoracic aorta and into the abdominal aorta hypomere.The patient died because of a sudden drop in blood pressure during transfer to vascular surgery.The clinical presentation of painless AAD mimics myelopathies.Aortic dissection should be considered in patients presenting with acute bilateral limb weakness.Physical examination of the skin temperature,dorsalis pedis artery,serum D-dimer,and myocardial markers can provide diagnostic clues.

Perspectives on potential neuroprotective role of albumin in acute ischemic stroke

Albumin is the most abundant protein in plasma and is synthesized primarily in the liver.It has a variety of biological roles,such as increasing colloid osmotic pressure, and performing antioxidant, anti-inflam-matory,and substance transportation functions.Several studies have confirmed that albumin has neuroprotective effects and it has been used in the treatment of cerebral edema and increased intracranial pressure.In this review we focus on the neuroprotective effects of albumin in ischemic stroke,such as the reduction of cerebral edema, antioxidant effects, protection of neuronal cell membranes, and increased cerebral blood flow. In addition, we summarize preclinical and clinical studies of albumin in ischemic stroke. We believe that the neuroprotective role of albumin should be re-investigated in the era of reperfusion therapy.

Severe pseudo-stenosis of intracranial segment of verte-bral artery:a case report

Objective:To describe the clinical fea-tures of a case of ischemic stroke caused by pseudo severe stenosis of vertebral artery(VA).Methods:The clinical history and image data of a 52-year-old man with ischemic stroke were collected.Results:Computerized tomography angiography(CTA)revealed stenosis of V1 and V4 of the left VA.DSA confirmed that the anterior blood flow recov-ered after stent implantation,and the V4 segment of the left VA was normal without stenosis.Conclusions:It is spec-ulated that the upper stenosis is due to local hemodynamic changes rather than real stenosis.This case suggests that the interpretation of stenosis on CTA should consider cere-bral vascular anatomy and hemodynamic changes.

低温自体血靶向回输对于非人灵长类脑卒中模型的神经保护作用

近几十年来,虽然研究已经证明治疗性低温在啮齿类动物脑卒中模型中有神经保护作用,但其临床转化却未能成功.可能的原因是不同物种之间的生物学差异以及转化研究中治疗性低温诱导难以有效实施.本研究介绍了一种基于非人灵长类动物缺血再灌注模型的选择性治疗性低温疗法,即将自体血于体外循环中冷却,在血管再通后立即通过微导管向缺血区域回输低温自体血.低温自体血将目标脑区迅速冷却至34℃以下,而核心温度可以维持在36℃左右.低温自体血回输减少了梗死面积,保留了白质完整性,改善了神经功能且未引发低温相关并发症.本研究结果表明,在非人灵长类动物脑卒中模型中,通过冷自体输血诱导治疗性低温是一种可行、快速和安全的方法.这提示低温自体血靶向回输是一种具有临床转化潜力的新型低温脑保护疗法.

Dual-sized hollow particle incorporated fibroin thermal insulating coatings on catheter for cerebral therapeutic hypothermia

Selective endovascular hypothermia has been used to provide cooling-induced cerebral neuroprotection,but current catheters do not support thermally-insulated transfer of cold infusate,which results in an increased exit temperature,causes hemodilution,and limits its cooling efficiency.Herein,air-sprayed fibroin/silica-based coatings combined with chemical vapor deposited parylene-C capping film was prepared on catheter.This coating features in dual-sized-hollow-microparticle incorporated structures with low thermal conductivity.The infusate exit temperature is tunable by adjusting the coating thickness and infusion rate.No peeling or cracking was observed on the coatings under bending and rotational scenarios in the vascular models.Its efficiency was verified in a swine model,and the outlet temperature of coated catheter(75μm thickness)was 1.8-2.0◦C lower than that of the uncoated one.This pioneering work on catheter thermal insulation coatings may facilitate the clinical translation of selective endovascular hypothermia for neuroprotection in patients with acute ischemic stroke.

Improving Long-Term Functional Outcomes of Ischemic Stroke in the Reperfusion Era

1.Introduction Stroke remains the second leading cause of death and the third leading cause of death and disability combined worldwide,as indicated by disability-adjusted life-years(DALYs)lost[1].The highest burden of stroke disability is observed in developing countries of Asia and the stroke belt of the United States[2].Despite remarkable progress and advancements in evidence-based acute care therapies,such as intravenous thrombolysis and endovascular therapy,the burden of stroke remains significantly high[3].In 2023,a significant advancement in the treatment of ischemic stroke due to proximal intracranial arterial occlusion was marked by compelling evidence from several clinical trials that supported endovascular therapy,particularly for patients with a large ischemic core[4].Thus,endovascular therapy has entered a new era since the first clinical trial favoring endovascular therapy.However,more patients receiving endovascular therapy does not equal a better prognosis.Patients with stroke experience long-term dysfunction,and the percentage is much higher in patients with large ischemic cores.Therefore,numerous tasks must be performed to optimize acute stroke treatment strategies and improve rehabilitative care.

Association between fluid-attenuated inversion recovery vascular hyperintensity and outcome varies with different lesion patterns in patients with intravenous thrombolysis

Background and purpose To evaluate relationship between fluid-attenuated inversion recovery vascular hyperintensity(FVH)after intravenous thrombolysis and outcomes in different lesion patterns on diffusion-weighted imaging(DWI).Methods Patients with severe internal carotid or intracranial artery stenosis who received intravenous thrombolysis from March 2012 to April 2019 were analysed.They were divided into four groups by DWI lesion patterns:border-zone infarct(BZ group),multiple lesions infarct(ML group),large territory infarct(LT group),and single cortical or subcortical lesion infarct(SL group).Logistic regression was performed to identify risk factors for outcome(unfavourable outcome,modified Rankin Scale(mRS)≥2;poor outcome,mRS≥3).Results Finally,203 participants(63.3±10.2 years old;BZ group,n=72;ML group,n=64;LT group,n=37;SL group,n=30)from 1190 patient cohorts were analysed.After adjusting for confounding factors,FVH(+)was associated with unfavourable outcome in total group(OR 3.02;95%CI 1.49 to 6.13;p=0.002),BZ group(OR 4.22;95%CI 1.25 to 14.25;p=0.021)and ML group(OR 5.44;95%CI 1.41 to 20.92;p=0.014)patients.FVH(+)was associated with poor outcome in total group(OR 2.25;95%CI 1.01 to 4.97;p=0.046),BZ group(OR 5.52;95%CI 0.98 to 31.07;p=0.053)and ML group(OR 4.09;95%CI 1.04 to 16.16;p=0.045)patients,which was marginal significance.FVH(+)was not associated with unfavourable or poor outcome in LT and SL groups.Conclusion This study suggests that association between FVH and outcome varies with different lesion patterns on DWI.The presence of FVH after intravenous thrombolysis may help to identify patients who require close observations in the hospitalisation in patients with border-zone and multiple lesion infarcts.