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.

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.

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.

EXPERIENCE IN THE POINT-SELECTION FOR ELECTRO-ACUPUNCTURE

Point selection along the course of meridians is the basic principle for acupuncture prescription and selection of points. In application, there are three categories of point selection: selection of local and adjacent points; selection of distant points, and selection of symptomatic points. Based on the

CLINICAL OBSERVATION ON 219 CASES OF ARM-NUMBNESS TREATED BY ACUPUNCTURE AT THE EXPERIENTIAL POINT BILING

The authors found an experiential point, called ’Biling (臂灵)’, in the treatment of arm-numbness due to various causes. 219 cases of patients were thus treated with good therapeutic effect as reported in the following.

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.

Treatment of 30 Cases of Hiccup due to Cerebral Disorders by Acupoint-injecting Method

Thirty cases of hiccup due to cerebral disorders were treated by injecting 2 ml ofAngelica Injection into bilateral Geshu (BL 17) and another 30 cases were treated by muscular injection of 30 mg of metoclopramide as the control group. After the treatments for three days, the total effective rate was 100% in the former and 83.3% in the latter. Key Words Cerebrovascular Disorders - Hiccup - Hydro-acupuncture Translator: HUANG Guo-qi

Observation on Therapeutic Effect of Acupucnture plus Rehabilitation for Hemiplegia Following Stroke

Objective： To observe the therapeutic effect of acupuncture plus rehabilitation on hemiplegia following stroke. Methods： Ninety-six patients with hemiplegia due to stroke were randomly allocated into two groups. The treatment group （50 cases） was treated with acupuncture plus rehabilitation, and the control group （46 cases） was treated with rehabilitation. Results： The total effective rate was 92.0% in the treatment group and 76.1% in the control group. There was a statistical difference in the effects between the two groups （P〈0.05）. Conclusion： Acupuncture plus rehabilitation is a perfect method for hemiplegia following stroke. It is especially effective in improving the function of limbs, relieving the spasm and improving the activity of daily life.

Effects of acupuncture plus language training on language function and cerebral blood flow in patients with motor aphasia after ischemic stroke

Objective:To observe the effects of acupuncture at the Governor Vessel acupoints plus language training on the language function and cerebral blood flow in patients with motor aphasia after ischemic stroke.Methods:Eighty-six patients were randomized into a control group and an observation group,with 43 cases in each group.Conventional symptomatic treatment was offered to both groups.Besides,the control group received language training,while the observation group received language training plus additional acupuncture at the Governor Vessel acupoints.Before and after treatment,the aphasia battery of Chinese(ABC)and Chinese functional communication profile(CFCP)were tested,and the mean velocity(Vm)and resistance index(Rl)of the left middle cerebral artery(MCA)were detected.Results:The total effective rate was higher in the observation group than in the control group(P<0.05).After treatment,the observation group gained higher scores in oral expression,comprehension,repeating,naming objects,reading,and writing,as well as the general score of ABC(all P<0.Q5)f higher than those in the control group(all P<0.05).The CFCP score increased in both groups after intervention,showing significant intra-group differences(both P<0.05),and the CFCP score was higher in the observation group than in the control group(P<0.05).After treatment,Vm of the left side MCA in creased in the con trol group(P<0.05),while no significant change was observed in Rl(P>0.05);in the observation group,Vm of the left side MCA increased and Rl decreased signfiicantly compared with the baseline(both P<0.05),and were markedly different from those in the control group(both P<0.05).Conclusion:Acupuncture at the Governor Vessel acupoints plus language training can produce valid efficacy in treating motor aphasia after ischemic stroke;it can notably improve the language function,everyday oral communication ability,and in crease cere bral perfusion of the patients.

Observation on clinical effect of auricular acupoint sticking plus music therapy for post-stroke insomnia

Objective： To observe the clinical effect of auricular acupoint sticking plus music therapy for post-stroke insomnia. Methods： A total of 154 cases with post-stroke insomnia were randomly divided into a control group and an observation group by the random digital table, 77 cases in each group. The control group was treated by auricular acupoint sticking, while the observation group was treated by auricular acupoint sticking plus music therapy, to compare the clinical effects at the end of the treatment and three months after the treatment between the two groups. Results： At the end of treatment, the total effective rate was 98.7% in the observation group, remarkably higher than 89.6% in the control group, with a statistically significant difference between the two groups （P〈0.05）. Three months after the end of the treatment, the total effective rate was 90.9% in the observation group, remarkably higher than 80.5% in the control group, with a statistically significant difference between the two groups （P〈0.05）. Conclusion： Auricular acupoint sticking plus music therapy was affirmative in the clinical effects for post-stroke insomnia, providing a new idea to design a best nursing and rehabilitative plan for the patients with post-stroke insomnia.

Establishing Stroke Unit on the Basis of TCM Characteristics

The evidence-based medicine proved that Stroke Unit （SU） works most effectively on stroke. Since SU is originated and developed in Europe and America, SU therapies are limited to Western medicine. We can make flexible clinical guidelines by combining TCM with the SU and establish SU mode with Chinese characteristics.

Reinforcing and Reducing Manipulation by Breathing on Yin and Yang Meridian Points for Motor Function of Knee Joints in Patients with Ischemic Stroke

Objective: To observe the effect of reinforcing and reducing manipulation by breathing on yin and yang meridian points for motor function of knee joints in patients with ischemic stroke. Methods: A total of 60 ischemic stroke cases were randomly allocated into an observation group and a control group, 30 in each group. Other than basic and conventional rehabilitation therapies, cases in the observation group were treated with reinforcing and reducing manipulation on yin and yang meridians points for a period of 8 weeks; whereas cases in the control group only received the same basic and conventional rehabilitation therapy as that in the observation group. Then the knee joint energy, support moment and shaking moment were compared between the two groups before treatment, and after 4-week and 8-week treatment respectively. Results: Before treatment, there were no between-group significant differences in knee joint energy, support moment and shaking moment(all P>0.05). After treatment, the knee joint energy, support moment and shaking moment in both groups were significantly improved(P<0.05). After 8 weeks of treatment, the knee joint energy, support moment and shaking moment in both groups were significantly improved than that of 4-week treatment(P < 0.05). In addition, there were between-group statistical significances in comparing knee joint energy, support moment and shaking moment after 4 and 8 weeks of treatment(P<0.05). Conclusion: Reinforcing and reducing manipulation by breathing on yin and yang meridian points can increase the knee joint support and shaking force and moment in stroke patients and improve their walking ability.

Ancient Acupuncture Literature on Apoplexy

This paper reviews twenty-eight Chinese medicine books with complete prescriptions prior to the Qing Dynasty, and analyzes the characteristics of acupoint selection and needling manipulations from the perspective of apoplectic symptoms. It is concluded that, in ancient times, apoplexy is often treated on the basis of its symptoms and a great number of acupoints are employed; hemiplegia is mainly treated by the acupoints of the Large Intestine Meridian and Gallbladder Meridian, with two key acupoints; coma is mainly treated by first-aid acupoints and qi-supplementing acupoints, with seven key acupoints; wry mouth and convulsion are mainly treated by the local acupoints; as for needling manipulations, moxibustion with moxa cones is principally used, while needling is less used. Key Words Cerebrovascular Disorders - Acupuncture-Moxibustion - Incunabula - Review Literature Translator: Xiao Yuan-chun

Patterns of Apoplectic Dysarthria and Acupuncture Treatment

In accordance with the feature of apoplectic dysarthria, it is divided into three types of labial pattern, lingual pattern and laryngeal pattern. The therapeutic methods are respectively explained with case examples. Key Words Cerebrovascular Disorders - Acupuncture Therapy - Dysarthria Translator: HUANG Guo-qi

Treatment of Swallowing Dysfunction after Cerebral Apoplexy by Acupuncture:A Report of 56 Cases

Fifty-six patients with swallowing dysfunction after cerebral apoplexy were treated by acupuncture and swallowing function training. The curative effect is satisfactory and the total effective rate was 96.4%.

Treatment of 40 Cases of Poststroke Shoulder-Hand Syndrome by Acupuncture

Acupuncture and rehabilitation therapies were used to treat 40 cases of shoulder-hand syndrome, the results show that integration of acupuncture and rehabilitation can increase therapeutic effects and shorten treatment courses to accelerate recovery.