Cerebrovascular disorder

209220 Clinical features and treatment of the hemorrhagic moyamoya disease/Duan Lian(Dept Neurosurg,Research Clinic,Acad Mil Med Sci,PLA,Beijing 100071)…∥Chin J Neurosurg.-2009,25(3).-201~204Objective To study the clinical features,bleeding reasons and strategies of the treatment of 61 patients with hemorrhagic moyamoya disease.Methods The clinical features of onset,bleeding location of the lesions and the type,characteristics of DSA images and therapeutic results were studied retrospectively.Results In all 61 patients,57 patients were adults.Most of them were cerebral hemorrhage breaking into ventricles.In all the hemisphere of hemorrhage,dilatation and abnormal branching of the AChA and P-CoM were observed in 52 patients,118 procedures of EDAS were performed,including superficial temporal basilar tip in 116 hemispheres and occipital artery in 2 hemispheres.There was no recurrence of hemorrhage in those operation patients.But 2 patients without EDAS died due to recurrence of hemorrhage Conclusion Dilatation and abnormal branching of the AChA and/or P-CoM are one of the main reasons for hemorrhagic events.The treatment of EDAS may be an effective method for preventing the recurrence of hemorrhage of hemorrhagic moyamoya disease.17 refs,2 figs.

Neuroplasticity in post-stroke gait recovery and noninvasive brain stimulation

Gait disorders drastically affect the quality of life of stroke survivors,making post-stroke rehabilitation an important research focus.Noninvasive brain stimulation has potential in facilitating neuroplasticity and improving post-stroke gait impairment.However,a large inter-individual variability in the response to noninvasive brain stimulation interventions has been increasingly recognized.We first review the neurophysiology of human gait and post-stroke neuroplasticity for gait recovery,and then discuss how noninvasive brain stimulation techniques could be utilized to enhance gait recovery.While post-stroke neuroplasticity for gait recovery is characterized by use-dependent plasticity,it evolves over time,is idiosyncratic,and may develop maladaptive elements.Furthermore,noninvasive brain stimulation has limited reach capability and is facilitative-only in nature.Therefore,we recommend that noninvasive brain stimulation be used adjunctively with rehabilitation training and other concurrent neuroplasticity facilitation techniques.Additionally,when noninvasive brain stimulation is applied for the rehabilitation of gait impairment in stroke survivors,stimulation montages should be customized according to the specific types of neuroplasticity found in each individual.This could be done using multiple mapping techniques.

Scalp electroacupuncture at the Baihui acupoint (DU 20) improves functional recovery in rats with cerebral ischemia Association with increased expression of vascular endothelial growth factors

In this study, we induced cerebral infarction in rats by occluding the right middle cerebral artery, and tested the effects of electroacupuncture at the Baihui acupoint （DU 20）. Motor and sensory function was tested using Garcia’s scale and motor weakness grading, and the expression of vascular endothelial growth factor in the brain was quantified using immunoblotting and immunohistochemistry. We found that scalp electroacupuncture at DU 20 significantly improved motor performance and sensory function in rats with stroke, and this was accompanied by an increased expression of vascular endothelial growth factor in the ischemic brain tissue and peri-ischemic area. In addition, Pearson correlation analysis showed that the improvements in functional recovery were correlated with the increased expression of vascular endothelial growth factor.

Vascular depression for radiology: A review of the construct,methodology,and diagnosis

Vascular depression(VD)as defined by magnetic resonance imaging(MRI)has been proposed as a unique subtype of late-life depression.The VD hypothesis posits that cerebrovascular disease,as characterized by the presence of MRIdefined white matter hyperintensities,contributes to and increases the risk for depression in older adults.VD is also accompanied by cognitive impairment and poor antidepressant treatment response.The VD diagnosis relies on MRI findings and yet this clinical entity is largely unfamiliar to neuroradiologists and is rarely,if ever,discussed in radiology journals.The primary purpose of this review is to introduce the MRI-defined VD construct to the neuroradiology community.Case reports are highlighted in order to illustrate the profile of VD in terms of radiological,clinical,and neuropsychological findings.A secondary purpose is to elucidate and elaborate on the measurement of cerebrovascular disease through visual rating scales and semi-and fully-automated volumetric methods.These methods are crucial for determining whether lesion burden or lesion severity is the dominant pathological contributor to VD.Additionally,these rating methods have implications for the growing field of computer assisted diagnosis.Since VD has been found to have a profile that is distinct from other types of late-life depression,neuroradiologists,in conjunction with psychiatrists and psychologists,should consider VD in diagnosis and treatment planning.

Nervous function and manifestations of mental psychology in patients with post-stroke depression of different syndrome types of traditional Chinese medicine

BACKGROUND： Poly-criteria pathogenesis of patients with stroke causes diversity of syndrome types of traditional Chinese medicine （TCM）; meanwhile, complexity and diversity of pathological mechanism also play a key role in determining severity so as to induce effects on nervous function and manifestation of mental psychology in patients with post-stroke depression （PSD）. OBJECTIVE： To analyze the syndrome types of TCM with nervous function and manifestations of mental psychology in PSD patients so as to provide evidence for the treatment based on the syndrome differentiation. DESIGN： Contrast observation. SETTING： Departments of Neurology and Traditional Chinese Medicine, General Hospital of Fuxin Mining Industry Group. PARTICIPANTS： A total of 469 outpatients or inpatients with stroke were selected from the Department of Neurology, General Hospital of Fuxin Mining Industry Group from April 2002 to July 2005. All subjects met the diagnostic criteria of stroke established by the Fourth National Cerebrovascular Disease Academic Meeting in 1995 and were finally diagnosed with CT and MRI. Totally, 177 PSD patients were involved in the final analysis and provided the confirmed consent. There were 121 males and 56 females aged from 46 to 79 years. METHODS： （1） All the enrolled subjects were diagnosed for syndrome differentiation by senior TCM physicians within 1 week before discharge based on Diagnostics of Traditional Chinese Medicine, which was classified into 5 types, including sputum-stasis stagnation syndrome, qi stagnation and blood stasis, kidney-essence deficiency, deficiency of the spleen and stomach and phlegm-fire disturbing the heart. In addition, they were also assessed by neurologic deficit scale （NDS; 45 points in total; the higher the scores were, the severer the deficit was）, Fugl-Meyer assessment, （FMA; 100 points in total, including 66 points of upper limbs and 34 points of lower limbs; the higher the scores were, the stronger the motor function was）, modified Barthel index [BI; 100 points in total; the higher the scores were, the better the activity of daily life （ADL） was], symptom checklist-90 （SCL-90; including total scores, positive scores, mean and average scores of positive items）, Hamilton depression rating scale （HAMD） and Hamilton anxiety rating scale （HAMA, the higher the scores were, the severer the degree was）. （2） Patients were divided into one symptom type, two symptom types and ≥ 3 symptom types; meanwhile, they were also divided into deficiency symptom, excess symptom and deficiency-excess symptom. Scores among various groups were compared simultaneously. MAIN OUTCOME MEASURES： Comparison of nervous function and mental psychology of PSD patients with various symptoms. RESULTS： （1） Differences of various symptoms： Among 177 patients, there were 43 subjects in the types of sputum-stasis stagnation, 64 in qi stagnation and blood stasis, 21 in kidney-essence deficiency, 33 in deficiency of the spleen and stomach, and 16 in phlegm-fire disturbing the heart. In the comparison of the scores of nervous function and psychological tests among different syndrome types, the scores of most motor functions of upper and lower limbs, total scores of FMA and ADL in PSD patients of sputum-stasis stagnation, qi stagnation and blood stasis, kidney-essence deficiency were obviously lower than those of the total samples and PSD patients of deficiency of the spleen and stomach and phlegm-fire disturbing the heart, whereas the total scores of NDS, HAMD, HAMA, SCL-90 and SCL-90 positive items, average number of SCL-90 positive items and average score of SCL-90 positive items in the former three groups were all obviously higher than those in the latter three groups （P 〈 0.05 - 0.01）. （2） Different number of syndrome types： In the comparison of the scores of nervous function and psychological tests among the PSD patients with different number of syndrome types, the scores of most motor functions of upper and lower limbs, total scores of FMA and ADL in PSD patients with one or two syndrome types were obviously higher than those of the total samples and the PSD patients with three or more syndrome types, whereas the total scores of NDS, HAMD, HAMA, SCL-90 and SCL-90 positive items, average number of SCL-90 positive items and average score of SCL-90 positive items were all obviously lower in the former two than in the latter two （P 〈 0.05 - 0.01）. （3） There were no obvious differences in the scores of most items of nervous function and psychological tests among the PSD patients of deficiency syndrome, excess syndrome and the deficiency-excess syndrome （P 〉 0.05）. CONCLUSION： The damages of nervous function and mental psychology are more serious in PSD patients with the syndrome types of sputum-stasis stagnation, qi stagnation and blood stasis, kidney-essence deficiency, as well as those with several （three or more） syndrome types, and the conditions may be improved by the treatment based on TCM syndrome differentiation.

Factors associated with delayed intracerebral hemorrhage after superficial temporal artery-middle cerebral artery bypass in stenoocclusive cerebrovascular diseases

Background Intra-cerebral hemorrhage （ICH） is a devastating complication that can result from superficial temporal artery-middle cerebral artery （STA-MCA） bypass in patients undergoing treatment for steno-occlusive cerebrovascular disease （CVD）.There is a clinical need to find the possible risk factors to prevent ICH,as it is a significant cause of mortality and morbidity.The aim of the study was to investigate the factors associated with delayed ICH after STA-MCA bypass in patients with steno-occlusive CVDs.Methods We retrospectively analyzed the records of 163 patients seen from 2002 to 2011 with STA-MCA bypass for steno-occlusive cerebrovascular diseases at the Department of Neurosurgery,Xuan Wu Hospital,Beijing.Demographic and clinical data,including age,gender,vascular risk factors,preoperative syndrome,preoperative National Institutes of Health Stroke Scale （NIHSS）,ipsilateral ischemic lesions,classification of steno-occlusive CVDs,donor branches of STA,graft patency,postoperative hypertension,and postoperative-increased MCA velocity were recorded and analyzed.Binary Logistic regression served to identify factors associated with delayed ICH after STA-MCA bypass.Results We identified 8 （4.9%） patients with delayed ICH after STA-MCA bypass.Patients with hypertension,preoperative stroke,ipsilateral ischemic lesions,postoperative hypertension and postoperative-increased MCA velocity were significantly more prone to experiencing delayed ICH after STA-MCA bypass.Logistic regression analysis shows ipsilateral ischemic lesions,postoperative hypertension,and postoperative-increased MCA velocity remained independent predictors for delayed ICH after STA-MCA bypass.Conclusion Despite the varied associated factors in patients with steno-occlusive CVDs,ipsilateral ischemic lesions,postoperative hypertension,and postoperative-increased MCA velocity could be associated with delayed ICH after STAMCA bypass.

Increased risk of cardio-cerebrovascular disease after hematopoietic cell transplantation in patients with previous history

Background:The impacts of previous cardio-cerebrovascular disease(pre-CCVD)on the outcomes of hematopoietic cell transplantation(HCT)are not well described.Patients with pre-CCVD may often be poor candidates for HCT.This study aimed to investigate the impact of pre-CCVD on transplant outcomes.Methods:A retrospective study was conducted between patients with and without pre-CCVD who consecutively received allogeneic or autologous HCT between November 2013 and January 2020 with a matching of age and disease status.The cardiovascular complications and HCT outcomes of the two groups were evaluated and compared.The primary endpoints were post-transplant cardio-cerebrovascular disease(post-CCVD)and non-relapse mortality(NRM).We used a multivariable Cox proportional hazard model and the Fine-Gray competing risk regressions for analyses to estimate the hazard ratios(HRs).Results:The outcomes of 23 HCT recipients with pre-CCVD were compared with those of 107 patients in the control group.No significant differences were noted in terms of engraftment,overall survival(OS)(67.00%vs.67.90%,P=0.983),or relapse(29.78%vs.28.26%,P=0.561)between the pre-CCVD group and the control group.The cumulative incidences of 2-year NRM were similar between patients with pre-CCVD and the controls(14.68%vs.17.08%,P=0.670).However,pre-CCVD was associated with an increased incidence of post-CCVD(HR:12.50,95%confidence interval[CI]:3.88–40.30,P<0.001),which was an independent risk factor for increased NRM(HR:10.29,95%CI:3.84–27.62,P<0.001)and inferior OS(HR:10.29,95%CI:3.84–27.62,P<0.001).Conclusions:These findings suggest that the existence of pre-CCVD before transplantation might not result in increased mortality directly but superpose the toxicity of the transplantation procedure,leading to a risk of post-CCVD.Post-CCVD was a powerful predictor for high NRM and inferior OS.Further risk stratification of pre-CCVD is needed to reduce NRM in various transplantation settings.

Bibliometric analysis of China’s contribution to the knowledge system of cerebrovascular intervention

Background:Cerebrovascular disease has become the leading cause of death in China.The purpose of this article is to analyze China’s contribution to the interventional treatment of cerebrovascular diseases.Methods:Bibliometric analysis was used for evaluating the quantity,quality,research hotspots,and cooperation network of publications regarding interventional treatment of cerebrovascular diseases from China.These articles were searched from the database of Web of Science Core Collection.The authors,publication years,citation times,regions,and source journals of retrieved articles were recorded.Network analysis and visualization were performed on Citespace5.6.Results:From 1991 to 2019,a total of 5052 articles regarding cerebrovascular intervention were contributed by Chinese researchers.The number of publications from China grew fastest annually in the latest 5 years among countries.These publications were cited 61,216 times,with 12.12 average citations per item.The h-index was 82.Affiliated hospitals of Capital Medical University contributed most articles.Cerebral ischemia and intracranial aneurysm were the most popular keywords over the three decades.The timeline view of keywords indicated that cerebral ischemia always was a hot spot.Stent techniques were the main treatment tools and still had a strong developing trend.Neural regeneration and neuroprotection were the hot topics of basic researches related to cerebrovascular intervention.Conclusions:The number of researches grows rapidly in China over the decades,but the quality still needs further improvement.The increasing contributions of Chinese researchers to the global knowledge system of cerebrovascular intervention are promising.