Effects of professional rehabilitation training on the recovery of neurological function in young stroke patients

Young stroke patients have a strong desire to return to the society, but few studies have been conducted on their rehabilitation training items, intensity, and prognosis. We analyzed clinical data of young and middle-aged/older stroke patients hospitalized in the Department of Neurological Rehabilitation, China Rehabilitation Research Center, Capital Medical University, China from February 2014 to May 2015. Results demonstrated that hemorrhagic stroke （59.6%） was the primary stroke type found in the young group, while ischemic stroke （60.0%） was the main type detected in the middle-aged/older group. Compared with older stroke patients, education level and incidence of hyperhomocysteinemia were higher in younger stroke patients, whereas, incidences of hypertension, diabetes, and heart disease were lower. The average length of hospital stay was longer in the young group than in the middle-aged/older group. The main risk factors observed in the young stroke patients were hypertension, drinking, smoking, hyperlipidemia, hyperhomocysteinemia, diabetes, previous history of stroke, and heart disease. The most accepted rehabilitation program consisted of physiotherapy, occupational therapy, speech therapy, acupuncture and moxibustion. Average rehabilitation training time was 2.5 hours/day. Barthel Index and modified Rankin Scale scores were increased at discharge. Six months after discharge, the degree of occupational and economic satisfaction declined, and there were no changes in family life satisfaction. The degrees of other life satisfaction （such as friendship） improved. The degree of disability and functional status improved significantly in young stroke patients after professional rehabilitation, but the number of patients who returned to society within 6 months after stroke was still small.

Changes in cortical activation patterns accompanying somatosensory recovery in a stroke patient: a functional magnetic resonance imaging study

The somatosensory system plays a crucial role in executing precise movements by providing sensory feedback （Farrer et al., 2003; Rabin and Gordon, 2004）. Somatosensory dys- function is a common problem following stroke. In partic- ular, somatosensory impairments, such as impairment in touch, proprioception, light touch, and vibration have been frequently observed （Carey et al., 1993; Sullivan and Hed- man, 2008; Tyson et al., 2008）. Patients with somatosensory dysfunction show negative effects on motor control, and it sometimes becomes difficult to perform daily activities independently.

Recovery of multiply injured ascending reticular activating systems in a stroke patient

Consciousness is controlled by ular activating system （ARAS）. lower and upper parts between activation of the ascending retic- The ARAS consists mainly of the the thalamus and cerebral cortex （Edlow et al., 2012; Yeo et al., 2013; Jang et al., 2014）. Because the ARAS is composed of several neuronal circuits connecting the brainstem to the cortex. These neuronal connections begin from the reticular formation （RF） of the brainstem and the intralaminar nucleus of thalamus to the cerebral cortex （Gosseroes et al., 2011）. In addition, the ARAS system also includes several brainstem nuclei （such as dorsal raphe, locus coeruleus, pedun-culopontine nucleus, median raphe and parabrachial nucleus）, non-specific thalamic nuclei, hypothalamus, and basal forebrain （Fuller et al., 2011）.

Reorganization of injured anterior cingulums in a hemorrhagic stroke patient

In this study, we reported on a patient who showed a new neural tract between the injured anterior cingu- lums and the basal forebrain, as shown by diffusion tensor tractography （DTT）.

Association between the related characters of hemispatial neglect and prognosis in stroke patients

OBJECTIVE： To recognize the significances of the classification, evaluation, treatment, pathogenesis, etiological factors and related loci of hemispatial neglect （HSN） in the treatment and prognosis of stroke patients. DATA SOURCES： Articles related to HSN in stroke published in English from January 1985 to December 2002 were searched in Medline database by using the keywords of ＂stroke, hemispatial neglect （HSN）, rehabilitation＂. Chinese relevant professional works and articles were also referred to. STUDY SELECTION： The data were primarily checked. Inclusive criteria： ① articles about the HSN symptoms in stroke; ② articles about the classification, evaluation, treatment, pathogenesis, etiological factors and related loci of HSN, as well as the treatment and prognosis of stroke. The repetitive studies or reviews were excluded. DATA EXTRACTION ： Totally 474 articles related to HSN in stroke were collected, 43 of them were involved and 431 repetitive studies or reviews were excluded. DATA SYNTHESES： HSN can be classified as sensory neglect and motor neglect. Because HSN is caused by the injury of network structure which mediated directed attention, it is generally believed that the inferior parietal Iobule of dominant hemisphere is the most closely correlated with neglect. The main theories related to the pathogenesis of HSN at present include ＂internal instruction＂, ＂directed bradykinesia＂, ＂sensory attention＂, etc. The main clinical manifestations are setover in drawing lines, picture drawing towards one side, imitation towards one side, picture description towards one side, etc., which can be evaluated by the line bisection test, target cancellation test, picture drawing test and pegboard test. The most important thing for the treatment is to make the patients continuously concentrate on the neglected side. CONCLUSION： HSN is an indicator for the bad outcome of cerebrovascular disease, the symptoms take longer time to rehabilitate with slow recovery, but quite a few HSN patients will get good prognosis if timely treatment and proper program are given.

Neglected corticospinal tract injury for 10 months in a stroke patient

The corticospinal tract（CST）is an essential motor pathway in the human brain：particularly,it is essential for fine hand movements（Jang,2014）.Stroke patients can show more severe weakness when a partial injury of the CST is combined with apraxia.

Alternation in F-wave parameters of median nerve from unaffected extremity in stroke patients with hemiplegia under dynamic state

BACKGROUND: For many years, the extremities of stroke patients are divided into affected side and unaffected side according to clinical symptoms and body signs. Moreover, previous rehabilitation function training is developed simply aiming to the dysfunction manifested by unaffected extremity. Problems of unaffected extremity are always ignored, such as left- and right- side connection dysfunction, abnormal muscular tension of unaffected side and so on. OBJECTIVE: To observe neurophysiological change characteristics of unaffected extremity of stroke patients with hemiplegia by electromyographical method. DESIGN: Case-control observation. SETTING: First Hospital, Jilin University. PARTICIPANTS: Eighty stroke patients with hemiplegia confirmed by skull CT or MRI, who firstly hospitalized in the Department of Neurology, First Hospital, Jilin University between July 2004 and March 2005, were retrieved. They were scored > 8 points in Glasgow Coma Scale and had stable vital sign. Nineteen normal persons who received healthy examination in the clinic were involved in normal control group. Following the classification criteria of Brunnstrom's Recovery Stages of Stroke (BRSS), 80 stroke patients with hemiplegia were assigned into 3 groups: BRSS Ⅰ-Ⅱ group (n =36), BRSS Ⅲ-Ⅳ group (n =23) and BRSSⅤ-Ⅵ (n =21). METHODS: F-wave parameters of median nerve of unaffected extremity were detected by electromyographical technique. The recording electrode (muscular belly of abductor pollicis brevis) and reference electrode (first finger bone) were connected with grounding electrode. Stimulating electrode was placed in the median part of wrist joint with stimulation intensity of 130% that of threshold stimulation, stimulation frequency of 2 Hz, current pulse width of 0.2 ms, time course of 5 ms and sensitivity of 2 mV. The F-wave of median nerve of affected extremity under the resting stage (static status) and that of unaffected extremity under the maximum resistant contracted state were detected in order. The amplitude and appearance percentage of F wave were recorded. MAIN OUTCOME MEASURES: Comparison of F-wave parameters of median nerve between the unaffected extremity of stroke patients with hemiplegia and the extremity of control subjects under different status. RESULTS: All the patients accomplished the detection, and all of them participated in the final analysis. ①Under dynamic status, the amplitude and appearance percentage of F wave of unaffected extremity of patients in BRSS Ⅲ-Ⅳ group were significantly higher than those in the normal control group, respectively[(0.803 9±0.157 3) mV vs. (0.406 7±0.170 3) mV; (0.856 1±0.266 8)% vs. (0.650 0±0.197 6)%, P < 0.05]. Under static status, there were no significant differences in F-wave parameters of median nerve in the unaffected extremity of patients between BRSS Ⅰ-Ⅱ group and BRSS Ⅴ-Ⅵ group (P > 0.05). ②F-wave parameters of median nerve of unaffected extremity of patients in BRSS Ⅰ-Ⅱ group and BRSS Ⅴ-Ⅵ group under dynamic statewere higher than those under static status, without significant difference (P > 0.05), while the amplitude and appearance percentage of F wave of median nerve of unaffected extremity of patients in BRSS Ⅲ-Ⅳ group under dynamic statewere significantly higher than those under static state[(0.803 9±0.157 3) mV vs. (0.391 7±0.131 6) mV; (0.856 1±0.266 8 )% vs.(0.639 1 ±0.259 4)%,P < 0.05]. ③ There was no significant difference in F wave parameters among groups under static state(P > 0.05). However, under dynamic status, the amplitude and appearance percentage of F wave parameters of median nerve of unaffected extremity of patients in BRSS Ⅲ-Ⅳ group [(0.803 9±0.157 3) mV,(0.856 1±0.266 8)%] were significantly lower than those in the other two groups [(0.395 1±0.148 8),(0.437 1±0.157 6) mV;(0.612 5±0.232 8)%,(0.657 1±0.232 5)%,P < 0.05]. CONCLUSION: With the development of disease condition and the increase of muscular tension at anesthetic side, combination motor of affected extremity is caused following movement and muscular tension enhances to non-anesthetic-side. Therefore, F-wave parameters increase under dynamic status.

Neural regeneration by regionally induced stem cells within poststroke brains: Novel therapy perspectives for stroke patients

Ischemic stroke is a critical disease which causes serious neurological functional loss such as paresis. Hope for novel therapies is based on the increasing evidence of the presence of stem cell populations in the central nervous system (CNS) and the development of stem-cell-based therapies for stroke patients. Although mesenchymal stem cells (MSCs) represented initially a promising cell source, only a few transplanted MSCs were present near the injured areas of the CNS. Thus, regional stem cells that are present and/or induced in the CNS may be ideal when considering a treatment following ischemic stroke. In this context, we have recently showed that injury/ischemia-induced neural stem/progenitor cells (iNSPCs) and injury/ischemia-induced multipotent stem cells (iSCs) are present within post-stroke human brains and post-stroke mouse brains. This indicates that iNSPCs/iSCs could be developed for clinical applications treating patients with stroke. The present study introduces the traits of mouse and human iNSPCs, with a focus on the future perspective for CNS regenerative therapies using novel iNSPCs/iSCs.

Correlation between social support and depression in elderly stroke patients in the sequelae stage from five communities of Shanghai, China

Using a convenience sampling method, 81 aged patients who were between 6 and 24 months post-stroke were selected from five communities of Shanghai, China. The correlations between social support and depression, as well as other influential factors, were investigated. Results revealed that 46% （37/81） of the stroke patients suffered from depression. Depression was correlated with social support total scores and the two domains of subjective support and utilization. Older age, male gender, low income, absence of spouse and cerebral hemorrhage were risk factors for depression and identify more vulnerable groups.

High-quality Health Information Provision for Stroke Patients

Objective： High-quality information provision can allow stroke patients to effectively participate in healthcare decision-making, better manage the stroke, and make a good recovery. In this study, we reviewed information needs of stroke patients, methods for providing infbnllation to patients, and considerations needed by the information providers. Data Sources： The literature concerning or including information provision for patients with stroke in English was collected from PubMed published from 1990 to 2015. Study Selection： We included all the relevant articles on information provision for stroke patients in English, with no limitation of study design. Results： Stroke is a major public health concern worldwide, ttigh-quality and effective health information provision plays an essential role in helping patients to actively take part in decision-making and healthcare, and empowering them to effectively self-managc their long-standing chronic conditions. Different methods for providing information to patients have their relative merits and suitability, and as a result, the effective strategies taken by health professionals may include providing high-quality information, meeting patients＇ individual needs, using suitable methods in providing information, and maintaining active involvement of patients. Conclusions： It is suggested that to enable stroke patients to access high-quality health information, greater efforts need to be made to ensure patients to receive accurate and current evidence-based information which meets their individual needs. Health professionals should use suitable information delivery methods, and actively involve stroke patients in inforrnation provision.

Robot Guides Stroke Patients' Recovery

中风病人NancyWheelen目前正在一名特殊教练——被困扎在自己身上的机械手臂的协助下,信心实足地进行着一再重复的恢复性练习。发明者将之称为RUPERT-Robotic Upper Extremity Repetitive Therapy。目前RUPERT仍处于实验阶段,普遍而又有效的应用尚不可能。但是研究者表明,不久的将来,该疗法将帮助1/3的中风患者重新获得基本的活动能力。

Paradoxical brain embolism followed by percutaneous atrial septal closure： Stroke in a patient＇s thirties highlighting some issues surrounding brain stroke in an emergency setting

Brain stroke in patients younger than 40 deprivessociety of its work force. Paradoxical brain embolism（PBE） is sometimes responsible. PBE should never beoverlooked in emergency settings because its recurrencemay be preventable.

Motor relearning program and Bobath method improve motor function of the upper extremities in patients with stroke

BACKGROUND: In the natural evolution of cerebrovascular disease, unconscious use of affected extremity during drug treatment and daily life can improve the function of affected upper extremity partially, but it is very slow and also accompanied by the formation of abnormal mode. Therefore, functional training should be emphasized in recovering the motor function of extremity. OBJECTIVE: To observe the effects of combination of motor relearning program and Bobath method on motor function of upper extremity of patients with stroke. DESIGN: Comparison of therapeutic effects taking stroke patients as observation subjects. SETTING: Department of Neurology, General Hospital of Beijing Jingmei Group. PARTICIPANTS: Totally 120 stroke patients, including 60 males and 60 females, averaged (59±3) years, who hospitalized in the Department of Neurology, General Hospital of Beijing Jingmei Group between January 2005 and June 2006 were recruited. The involved patients met the following criteria: Stroke attack within 2 weeks; diagnosis criteria of cerebral hemorrhage or infarction made in the 4th National Cerebrovascular Disease Conference; confirmed by skull CT or MRI; Informed consents of therapeutic regimen were obtained. The patients were assigned into 2 groups according to their wills: rehabilitation group and control group, with 30 males and 30 females in each group. Patients in rehabilitation group averaged (59±2)years old, and those in the control group averaged (58±2)years old. METHODS: ① Patients in two groups received routine treatment in the Department of Neurology. When the vital signs of patients in the rehabilitation group were stable, individualized treatment was conducted by combined application of motor relearning program and Bobath method. Meanwhile, training of activity of daily living was performed according to the disease condition changes of patients at different phases, including the nursing and instruction of body posture, the maintenance of good extremity position, bed exercise, bedside sit up and sitting position balance, sit up exercise, dynamic and static balance exercise, walking exercise, active training and passive training. The strength, time and speed of training were increased gradually according to their physical abilities. Patients were trained 45 to 60 minutes once, 5 times a week, within 2 weeks. ② Evaluation criteria of therapeutic effect: The motor function of upper extremity was evaluated by Fugl-Meyer method on the day of beginning and end of treatment. Higher points indicated better function of upper extremity. ③ t test and paired t test were used for comparing the difference of intergroup and intragroup measurement data, respectively. MAIN OUTCOME MEASURES: Changes in Fugl-Meyer scoring of two groups before and after treatment. RESULTS: Totally 120 stroke patients participated in the final analysis. Before treatment, Fugl-Meyer scoring was close between rehabilitation group and control group [(14.47±2.38),(14.16±2.39) points, P > 0.05]; Fugl-Meyer scoring of rehabilitation group after treatment was significantly higher than that before treatment and that of control group[(37.93±2.67),(18.36±2.43) points, t =11.053, 5.408, P < 0.01]; There were no significant differences in Fugl-Meyer scoring between before treatment in the control group and control group (P > 0.05). CONCLUSION: Combined application of motor relearning program and Bobath method can significantly improve the motor function of upper extremity of patients with stroke.

Botulinum toxin type A plus rehabilitative training for improving the motor function of the upper limbs and activities of daily life in patients with stroke and brain injury

BACKGROUND: Botulinum toxin type A (BTX-A) is mostly to be used to treat various diseases of motor disorders, whereas its effect on muscle spasm after stroke and brain injury needs further observation. OBJECTIVE: To observe the effect of BTX-A plus rehabilitative training on treating muscle spasm after stroke and brain injury. DESIGN: A randomized controlled observation. SETTINGS: Department of Rehabilitation, Department of Neurology and Department of Neurosurgery, the Second Hospital of Hebei Medical University. PARTICIPANTS: Sixty inpatients with brain injury and stroke were selected from the Department of Rehabilitation, Department of Neurology and Department of Neurosurgery, the Second Hospital of Hebei Medical University from January 2001 to August 2006. They were all confirmed by CT and MRI, and had obvious increase of spastic muscle strength in upper limbs, their Ashworth grades were grade 2 or above. The patients were randomly divided into treatment group (n =30) and control group (n =30). METHODS: ① Patients in the treatment group undertook comprehensive rehabilitative trainings, and they were administrated with domestic BTX-A, which was provided by Lanzhou Institute of Biological Products, Ministry of Health (S10970037), and the muscles of flexion spasm were selected for upper limbs, 20-25 IU for each site. ② Patients in the treatment group were assessed before injection and at 1 and 2 weeks, 1 and 3 months after injection respectively, and those in the control group were assessed at corresponding time points. The recovery of muscle spasm was assessed by modified Ashworth scale (MAS, grade 0-Ⅳ; Grade 0 for without increase of muscle strength; Grade Ⅳ for rigidity at passive flexion and extension); The recovery of motor function of the upper limbs was evaluated with Fugl-Meyer Assessment (FMA, total score was 226 points, including 100 for exercise, 14 for balance, 24 for sense, 44 for joint motion, 44 for pain and 66 for upper limb); The ADL were evaluated with Barthel index, the total score was 100 points, 60 for mild dysfunction, 60-41 for moderate dysfunction, < 40 for severe dysfunction). MAIN OUTCOME MEASURES: Changes of MAS grade, FMA scores and Barthel index before and after BTX-A injection. RESULTS: All the 60 patients with brain injury and stroke were involved in the analysis of results. ① FMA scores of upper limbs: The FMA score in the treatment group at 2 weeks after treatment was higher than that before treatment [(14.98±10.14), (13.10±9.28) points, P < 0.05], whereas there was no significant difference at corresponding time point in the control group. The FMA scores at 1 and 3 months in the treatment group [(23.36±10.69), (35.36±11.36) points] were higher than those in the control group [(20.55±10.22), (30.33±10.96) points, P < 0.01]. ② MAS grades of upper limbs: There were obviously fewer cases of grade Ⅲ in MAS at 2 weeks after treatment than before treatment in the treatment group (0, 9 cases, P < 0.05), whereas there was no obvious difference in the control group. There were obviously fewer cases of grade Ⅲ in MAS at 2 weeks and 1 month after treatment in the treatment group (0, 0 case) than the control group (5, 2 cases, P < 0.01). ③ Barthel index of upper limbs: The Barthel index at 2 weeks after treatment was higher than that before treatment in the treatment group [(30.36±22.25), (28.22±26.21) points, P < 0.05], whereas there was no significant difference in the control group. The Barthel indexes at 1 and 3 months after treatment in the treatment group were obviously higher than those in the control group [(20.55±10.22), (30.33±10.96) points, P < 0.01]. CONCLUSION: BTX-A has obvious efficacy on decreasing muscle tension after stroke and brain injury, and relieving muscle spasm; Meanwhile, the combination with rehabilitative training can effectively ameliorate the motor function of upper limbs and ADL of the patients.

Observation of activation status of motor-related cortex of patients with acute ischemic stroke through functional magnetic resonance imaging

BACKGROUND： About more than three fourth of patients with stroke have motor dysfunction at different degrees, especially hand motor dysfunction. Functional magnetic resonance imaging （fMRI） provides very reliable visible evidence for studying central mechanism of motor dysfunction after stroke, and has guiding and applicable value for clinical therapy. OBJECTIVE： To observe the activation of motor-related cortex of patients with acute ischemic stroke with functional magnetic resonance imaging, and analyze the relationship between brain function reconstruction and motor restoration after stroke. DESIGN ： A contrast observation SETTING： Medical Imaging Center, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA. PARTICIPANTS ： Nine patients with acute ischemic stroke who suffered from motor dysfunction and received the treatment in the Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA between August and December 2005 were recruited, serving as experimental group. The involved patients including 5 male and 4 female, aged 16 to 87 years, all met the diagnostic criteria of cerebrovascular disease revised by The Fourth National Conference on Cerebrovascular Disease, mainly presenting paralysis in clinic, and underwent fMRI. Another 9 right handed persons matched in age and gender who simultaneously received healthy body examination were recruited, serving as control group. All the subjects were informed of the detected items. METHODS ： ①Muscular strength of patients of the experimental group was evaluated according to Brunnstrom grading muscular strength （Grade Ⅰ -Ⅳ）. ②Passive finger to finger motion was used as the mission （alternate style of quiescence, left hand motion and quiescence, nght hand motion was repeated 3 times, serving as 1 sequence, 20 s per block and 20 s time interval. The whole process of scanning was 260 s）, and subjects of 2 groups were given Bold-fMRI examination with GEl .5T double gradient 16-channel magnetic resonance imaging system. All the data were given off-line management, and fMRI was treated with SPM2 softwere. The activation of passive finger-to-finger motion-related cortex of subjects in 2 groups was observed. ③ Results of fMRI of subjects in 2 groups were compared. The size of activation region of brain and signal intensity were measured and unilateral index was calculated. The data of activation region of cerebral hemisphere of different sides at finger motion were given statistical analysis of unilateral index. Differences among unilateral indexes at hand motion were compared between intact and affected hands of patients in experimental group. The relationship between unilateral index and muscular strength of affected hands at affected hand motion in patients of the experimental group was performed Spearman correlation analysis. MAIN OUTCOME MEASURES： ① The activation of motion-related cortex passive finger-to-finger motion between handedness and non-handedness was detected with functional magnetic resonance imaging of subjects in 2 groups. ②Relationship between unilateral index and muscular strength of subjects of experimental group at affected hand motion. RESULTS： Nine patients with ischemic stroke and 9 controls all participated in the final result analysis. ① Passive fMRI detection results between handedness and non-handedness of controls： Right-handed finger-to-finger motion of subjects of control group mainly activated contralateral sensonmotor cortex, and left-handed finger-to-finger motion not only activated above-mentioned brain region, but also activated supplementary motor area （SMA） of contralateral brain region; ②In the experimental group, sensorimotor cortex of contralateral hemisphere was activated at affected hand motion, and homolateral posterior parietal cortex （PPC）was also obviously activated. Bilateral sensonmotor cortex was activated at affected hand motion in 2 patients, and homolateral activation area was larger than contralateral one. At intact hand motion, contralateral sensorimotor cortex was activated, but no obvious homolateral activation area was found. ③ Correlation of unilateral index with muscular strength： Passive finger-to-finger fMRI （ between affected and intact hands of subjects of experimental group： Unilateral index at passive single finger motion of affected and intact hand of subjects of experimental group was -0.018±0.01 and 0.319±0.187, respectively, with significant difference （t=4.059, P 〈 0.01 ）. Unilateral index was significantly positively correlated with the muscular strength of affected hand at affected hand motion（r=0.834, P 〈 0.05）.CONCLUSION ： ①fMRI can objectively shows different activation states of motor cortex between patients with ischemic stroke and healthy controls, and brain functional compensation and recombination exist. Both primary sensorimotor cortex and SMA of bilateral hemispheres participant in affected hand motion, at the same time, parietal lobe and cortex of intact side also obviously participant in the affected hand motion. ②Correlation analysis of unilateral index and muscular strength of affected hand performed through fMRI can be used as an effective means to investigate the relationship between motion rehabilitation and brain functional recombination after stroke.

Doppler examination and cerebral arterial stricture in patients with ischemic stroke

BACKGROUND: With the development of interventional therapy, it is necessary for evaluating cerebral vessels to instruct treatment and determine prognosis of patients with ischemic stroke; however, correlation of distribution of infarction focus and clinical symptoms with degrees of cerebrovascular stricture is still unclear. OBJECTIVE: To evaluate the characteristics of cerebral arterial stricture of patients with ischemic stroke with transcranial Doppler (TCD) and color duplex flow imaging (CDFI) and compare the correlation between distribution of cerebral infarction focus and clinical types with magnetic resonance imaging (MRI). DESIGN: Contrast observation. SETTING: Department of Neurology, the First Hospital of Jilin University. PARTICIPANTS: A total of 159 patients with ischemic stroke were selected from the Department of Neurology, the First Hospital of Jilin University from January to December 2005, including 106 males and 53 females aged from 27 to 88 years. Bases on diagnostic criteria of cerebrovascular disease established by Rao et al, clinical manifestations of all patients were evaluated with CT or nuclear magnetic resonance. All patients provided the confirmed consent. METHODS: The accepted patients received TCD and CDFI examination at 1 week after onset of ischemic stroke. Among them, 112 patients received cerebrovascular imaging examination simultaneously. MRI was used to check cerebral infarction focus and cerebrovascular stricture > 50% was regarded as the accepted vessels. In addition, DWI-T2 TCD (Germany) was used to check middle cerebral artery, and degrees of middle cerebral artery were classified into mild, moderate and severe stricture based on blood velocity (140 cm/s, 180 cm/s). Stroke was classified based on characteristics of infarction focus and clinical symptoms showed with MRI and correlation with degrees of cerebrovascular stricture was analyzed simultaneously. MAIN OUTCOME MEASURES: Correlation between the characteristics of ischemic stroke and clinical symptoms checked with TCD and CDFI. RESULTS: A total of 159 patients with ischemic stroke were involved in the final analysis; in addition, 112 cases received cerebrovascular imaging examination simultaneously. ① MRI results of 159 patients with cerebral artery occlusive disease (CAOD): There were 131 patients (82.3%) with cerebral infarction, 40 (25.2%) with transient ischemic attack and 4 (2.5%) with subclavian steal syndrome (SSS). ② Infarction types with MRI examination: There were 33 patients (20.8%) with solitary cerebral infarction and 98 (61.6%) with multiple-cerebral infarction. ③ Results of TCD, CDFI, MRI angiography, CT angiography and digital subtraction angiography (DSA): Among 112 patients, 181 lesion sites (61.8%) were located in cranium and 112 lesion sites were located out of cranium; especially, lesion site was mostly observed in stem of middle cerebral artery (31.2%) and watershed of basilar artery (7.2%) in cranium and the beginning site of internal carotid artery (21.4%) out of cranium. ④ Correlation of vascular stricture checking with TCD, MRI and clinical diagnosis: On one hand, MRI and clinical diagnosis demonstrated that 68 patients had a watershed infarction; meanwhile, TCD examination indicated that there were 3 patients with mild vascular stricture, 24 with moderate vascular stricture and 36 with severe vascular stricture. On the other hand, among 68 patients with non-watershed infarction, there were 27 patient with mild vascular stricture, 26 with moderate vascular stricture and 15 with severe vascular stricture. There were significant differences (χ2 =26.854, P =0.001). Clinical diagnosis indicated that 40 patients had transient ischemic attack and TCD examination demonstrated that there were 8 patient with mild vascular stricture, 12 with moderate vascular stricture and 20 with severe vascular stricture. There were significant differences as compared with 68 patients with watershed infarction (χ2 =21.258, P =0.001). ⑤ Correlation of vascular stricture checking with CDFI, MRI and clinical diagnosis: On one hand, among patients who were determined as watershed infarction with MRI and clinical diagnosis, CDFI examination indicated that there were 32 patients with mild vascular stricture at neck, 25 with moderate vascular stricture and 6 with severe vascular stricture. On the other hand, among patients with non-watershed infarction, there were 48 patient with mild vascular stricture, 18 with moderate vascular stricture and 2 with severe vascular stricture. There were significant differences (χ2 =6.018, P =0.019). Among patients with transient ischemic attack checking with clinical diagnosis, there were 23 patient with mild vascular stricture, 9 with moderate vascular stricture and 8 with severe vascular stricture. There were no significant differences as compared with patients with non-watershed infarction (χ2 =0.597, P =0.440). CONCLUSION: ① TCD and CDFI are effective marks to determine cerebral arterial stricture and hemodynamical changes. ② Infarction and transient ischemic attack at watershed are generally clinical phenotypes of CAOD patients and infarction at watershed is correlated with degrees of cerebrovascular stricture. ③ TCD, MRI and clinical analysis of stroke types are significant for instructing treatment and evaluate prognosis.

Influencing factors for the disappearance of hemispatial neglect in patients during acute stroke

BACKGROUND： Some researches are proved that early sitting balance and body motor control performed on patients with stroke and hemiplegia is related to functional prognosis. For patients with hemispatial neglect （HSN） dunng acute stroke, whether HSN disappearance is related to those trainings or not should be further studied. OBJECTIVE： To analyze the correlation between HSN disappearance and related intervention of patients during acute stroke. DESIGN ： Case analysis SETTING ： Department of Neurology, First Affiliated Hospital of Guangxi Medical University PARTICIPANTS： A total of 21 patients with stroke were selected from the Department of Neurology, the First Affiliated Hospital of Guangxi Medical University from May 2005 to March 2006. Diagnosis criteria： ① Stroke was diagnosed by CT and MRI; ② Diagnosis was coincidence with HSN evaluation criteria; ③ All cases were consent. Exclusion cnteda： Patients who had poly-focus, conscious disturbance, severe amentia and hard communication combined with aphasia were excluded. A total of 12 males and 9 females were included, and the mean age was （68±10） years. Among them, 14 patients had cerebral infarction and 7 had cerebral hemorrhage. METHODS： Disappearance and existence of HSN were analyzed with HSN evaluation criteria： body agnosia, left and nght agnosia, maintenance of supine position, place of things, sitting up straight, center of line measured by eyes, and cutting 30 lines with paring method, Items mentioned below belonged to HSN disappearance： ① without body agnosia; ② without left and nght agnosia; ③ be able to maintain supine position; ④ knowing place of things; ⑤ sitting up straight by one＇s own; ⑥ be able to measure the center of line by eyes; ⑦ be able to cut 30 lines with paring method. However, only one item belonged to HSN remnant; but only one item belonged to HSN remnant. Numbers of patients who were of body agnosia, left and nght agnosia and difficult maintenance of supine position were observed during acute period （within 1 week） and recovery period （at 2 weeks after onset）. Related factors with HSN disappearance contained time of physiotherapy, duration of sitting training （sitting in bed and near bedside： heels fallen to ground, feet loaded heavies, center of gravity located at middle line, head raised towards frontage） and hospitalized time. However, control group was not set up.Measurement data were expressed as Mean＋SD and compared with ttest; enumeration data were compared with Chi-square test and Mann-Whitney Utest. P 〈 0.05 was regarded as significant difference. MAIN OUTCOME MEASURES： ① HSN disappearance; ②Numbers of body agnosia, left and right agnosia and difficult maintenance of supine position;③ Correlation among therapeutic time, sitting-training time and hospitalized time. RESULTS： All 21 patients were involved in the final analysis. ① HSN disappearance： Among 21 cases, 2 patients had right HSN disappearance, 19 left HSN disappearance, 8 （38%, 8/21） HSN disappearance, and 13 （62%, 13/21） HSN remnant. Among 8 patients of HSN disappearance, symptoms of 4 cases lasted for 7 days and that of another 4 lasted for 8-12 days. ② Evaluation of HSN disappearance at various phases： Within 1 week, 19% （4/21） HSN patients had body agnosia, left and right agnosia; during recovery period, body agnosia of 20 cases was disappeared and that of 1 case was still survived. Within 1 week, cases with difficult maintenance of supine position were 67% （13/21）, but 43% （17/21） during recovery period. ③ Analysis of effective factors on HSN disappearance and related intervention： At acute phase, HSN disappearance through sitting training lasted for （2.5±1.3） days, and remaining HSN symptoms were relieved for （5.0±3.7） days. There was significant difference between them （ x^2= 3.96, P = 0.039）. The hospitalized time of patients with HSN disappearance and HSN remnant was （17.6±10.4）, （16.2±4.9） days, but there was no significant difference between them （x^2 = 1.41, P = 0.679）. Physiotherapy time of patients with HSN disappearance and HSN remnant was （11.1 ±7.5）, （11.4±4.1 ） days, but there was no significant difference between them （x^2 = 1.05, P = 0.894）. CONCLUSION： Early sitting training may play a possible role in HSN symptom disappearance of patients with stroke.

Anterior Choroidal Artery Territory Stroke in Young Patient

Introduction: Stroke incidence in young patients is about 10 cases in 100.000, according to several European studies. In this age group arterial dissection is one of the main pathological mechanisms involved. The internal carotid’s artery (ICA) main supraclinoid branch is the anterior choroidal artery (AChA). The occurrence of infarction in its territory due to internal carotid dissection is considered to be a rare event and may have different clinical presentations due to anatomical variability. Clinical case: A 31-year-old male patient, without any known cardiovascular risk factors or chronic medication, presented with acute onset of stabbing right sided headache while practicing football. Visual disturbances and hemiparesis with hypesthesia of his left arm were also mentioned. On admission left homonymous hemianopsia, left hemiparesis and left extensor plantar reflex were present. Brain magnetic resonance showed hyperintensity of T2 and FLAIR signals and restricted diffusion pattern suggested acute/subacute infarctions in the thalamic and subcapsular area, corpus callosum, splenium and subcortical parietal right region. Magnetic resonance angiography (MRA) of the brain showed reduction of the right ICA’s caliber, mainly of its supraclinoid segment in which a marked irregular stenosis was visualized, suggestive of arterial dissection. This stenotic segment included the origin of the AChA and of the posterior communicating cerebral artery with an exchange in their territories. Lumbar puncture results were normal as were analytical investigations which included CBC, sedimentation rate, syphilis serology and immunologic and prothrombotic screen. There were no phenotype characteristics suggestive of connective tissue disease. Conclusion: Trauma seems to be the most probable lesion mechanism for the occurrence of intracranial carotid’s dissection in this particular case, as the patient was practicing vigorous sports at time of onset. In view of great anatomic variability and multiple anatomical sites supplied by the AChA its occlusion will induce a wide range of clinical manifestations.