Generalized seizure, the only manifestation of a small ischemic atherothrombotic infarction

BACKGROUND:According to the literature,generalized seizure as a presenting sign of stroke is rare,and in the reported cases it was accompanied by a focal neurological deficit.Presentation of a small ischemic atherothrombotic brain infarction with convulsive generalized seizure is very rare.METHODS:We reported a patient with acute small ischemic atherothrombotic infarction associated with an episode of generalized tonic-clonic seizure,a rare clinical manifestation in this type of stroke.The patient was treated with anti-epileptic therapy after admission.RESULTS:The patient was discharged with oral administration of phenytoin 100 mg TDS,aspirin 80 mg daily,and atorvastatin 40 mg daily.CONCLUSION:Small ischemic atherothrombotic infarction can present only with a seizure without any focal neurological deficit.

Clinical Observation of Intravenous Nimotop in Comparison with Mailuoning Therapy in Cerebral Infarction

The effect of intravenous Nimotop, a calciumchannel antagonist, in the treatment of cerebral infarction in 32 patients was compared with that of 45 control patients treated with traditional Chinese medicine Mailuoning. In the former the total effective rate was 96.9% while in the latter, 88.9% (P>0.05). Both had good effects on patients with cerebral infarction. The effectual rates of the two groups were 81.3% and 60.0% (P<0.05) respectively. Nimotop had a more significant effect on the recovery of neurological deficits and a better effect on the patients in the early stage of the disease with or without mental impairment.

Computed tomography perfusion and computed tomography angiography for prediction of clinical outcomes in ischemic stroke patients after thrombolysis

Cerebral blood perfusion and cerebrovascular lesions are important factors that can affect the therapeutic efficacy of thrombolysis.At present,the majority of studies focus on assessing the accuracy of lesion location using imaging methods before treatment,with less attention to predictions of outcomes after thrombolysis.Thus,in the present study,we assessed the efficacy of combined computed tomography（CT） perfusion and CT angiography in predicting clinical outcomes after thrombolysis in ischemic stroke patients.The study included 52 patients who received both CT perfusion and CT angiography.Patients were grouped based on the following criteria to compare clinical outcomes：（1） thrombolytic and non-thrombolytic patients,（2） thrombolytic patients with CT angiography showing the presence or absence of a vascular stenosis,（3） thrombolytic patients with CT perfusion showing the presence or absence of hemodynamic mismatch,and（4） different CT angiography and CT perfusion results.Short-term outcome was assessed by the 24-hour National Institution of Health Stroke Scale score change.Long-term outcome was assessed by the 3-month modified Rankin Scale score.Of 52 ischemic stroke patients,29 were treated with thrombolysis and exhibited improved short-term outcomes compared with those without thrombolysis treatment（23 patients）.Patients with both vascular stenosis and blood flow mismatch（13 patients） exhibited the best short-term outcome,while there was no correlation of long-term outcome with CT angiography or CT perfusion findings.These data suggest that combined CT perfusion and CT angiography are useful for predicting short-term outcome,but not long-term outcome,after thrombolysis.

Electroacupuncture improves neurovascular unit reconstruction by promoting collateral circulation and angiogenesis

Acupuncture at Shuigou（GV26） shows good clinical efficacy for treating stroke, but its mechanism remains poorly understood. In this study, a cerebral infarction model of ischemia/reperfusion injury received electroacupuncture at GV26（15 Hz and 1 m A, continuous wave [biphasic pulses], for 5 minutes）. Electroacupuncture effectively promoted regional cerebral blood flow on the infarct and non-infarct sides, increased infarct lesions, lectin, and number of blood vessels, upregulated von Willebrand factor and cell proliferation marker Ki67 expression, and diminished neurological severity score. These findings confirm that electroacupuncture at GV26 promotes establishment of collateral circulation and angiogenesis, and improves neurological function.

Three-dimensional arterial spin labeling and diffusion kurtosis imaging in evaluating perfusion and infarct area size in acute cerebral ischemia

BACKGROUND Early thrombolytic therapy is crucial to treat acute cerebral infarction,especially since the onset of thrombolytic therapy takes 1-6 h.Therefore,early diagnosis and evaluation of cerebral infarction is important.AIM To investigate the diagnostic value of magnetic resonance multi-delay threedimensional arterial spin labeling(3DASL)and diffusion kurtosis imaging(DKI)in evaluating the perfusion and infarct area size in patients with acute cerebral ischemia.METHODS Eighty-four patients who experienced acute cerebral ischemia from March 2019 to February 2021 were included.All patients in the acute stage underwent magnetic resonance-based examination,and the data were processed by the system’s own software.The apparent diffusion coefficient(ADC),average diffusion coefficient(MD),axial diffusion(AD),radial diffusion(RD),average kurtosis(MK),radial kurtosis(fairly RK),axial kurtosis(AK),and perfusion parameters post-labeling delays(PLD)in the focal area and its corresponding area were compared.The correlation between the lesion area of cerebral infarction under MK and MD and T2-weighted imaging(T2WI)was analyzed.RESULTS The DKI parameters of focal and control areas in the study subjects were compared.The ADC,MD,AD,and RD values in the lesion area were significantly lower than those in the control area.The MK,RK,and AK values in the lesion area were significantly higher than those in the control area.The MK/MD value in the infarct lesions was used to determine the matching situation.MK/MD<5 mm was considered matching and MK/MD≥5 mm was considered mismatching.PLD1.5s and PLD2.5s perfusion parameters in the central,peripheral,and control areas of the infarct lesions in MK/MD-matched and-unmatched patients were not significantly different.PLD1.5s and PLD2.5s perfusion parameter values in the central area of the infarct lesions in MK/MD-matched and-unmatched patients were significantly lower than those in peripheral and control areas.The MK and MD maps showed a lesion area of 20.08±5.74 cm^(2) and 22.09±5.58 cm^(2),respectively.T2WI showed a lesion area of 19.76±5.02 cm^(2).There were no significant differences in the cerebral infarction lesion areas measured using the three methods.MK,MD,and T2WI showed a good correlation.CONCLUSION DKI parameters showed significant difference between the focal and control areas in patients with acute ischemic cerebral infarction.3DASL can effectively determine the changes in perfusion levels in the lesion area.There was a high correlation between the area of the infarct lesions diagnosed by DKI and T2WI.

Development of 3-actoxymethoxycarbonyl-2,2,5,5-tetramethyl-1-pyrrolidinyloxyl as an electron paramagnetic resonance imaging reagent for in vivo mapping brain oxygen distribution and infarction in ischemic brain

Measurement of oxygen concentration and distribution in brain is essential to understanding the pathophysiology of stroke. Although brain oxygen level is critical for brain tissue survival,

Nitric oxide opens second window of protection in ischemic preconditi oningvia induction of heat-shock protein 72

To examine the inhibition of nitric oxide (NO) synthesis during ischemi c preconditioning (IP) upon the induction of heat shock protein 72 (HSP72) and the size limiting effect of the second window of protection on infarction Methods Rabbits were subjected to either 4 cycles of 5 min long coronary artery occl usion separated by 10 min of reperfusion, or a sham operation During this procedure, we administered 10 mg/kg of N G nitro L arginine methyl ester (L N AME, an inhibitor of NO synthase) intravenously 5 min before IP followed by its continuous infusion (1 5 mg/kg/min) Twenty four hours after IP or the sh am operation, the hearts were rapidly excised for assay of HSP72 expression or w ere subjected to 30 min of coronary artery occlusion followed by 120 min of rep erfusion, at which point infarct size (IS) was measured Results Twenty four hours after IP or the sham operation, there was no difference in he art rate or mean arterial pressure between the groups Immunoblotting revealed an increase in HSP72 protein levels in the IP group, which was blocked by L NAM E IS in the IP rabbits was reduced compared with controls (29 8±3 7% vs 50 8±4 3 %, P <0 01) IS in the IP rabbits was elevated as a result o f L NAME treatment (46 0±5 1%) Administration of L arginine reversed the effects of L NAME on the induction of HSP72 and IS (33 5±4 0%) The intrave nous administration of S nitroso N acetylpenicillamine (an NO donor, 15 μg /kg/min) over 20 min increased the induction of HSP72 and reduced IS (31 3±5 7%, P <0 01 vs control) 24 h later Conclusion These findings suggest that NO may be involved in the induction of HSP72 and the opening of the second window of protection of IP