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.

Early application of percutaneous neuromuscular electric stimulation in interfering motor function of limbs and difference in temperature of axilla of patients with ischemic stroke

BACKGROUND： Temperature of axilla could be affected due to motor dysfunction of limbs and neural changes of vessel after ischemic stroke. OBJECTIVE： To observe the effect of percutaneous neuromuscular electric stimulation （PNES） on difference in temperature of axilla and analyze the relationship between function of limbs and difference in temperature of axilla. DESIGN： Randomized grouping and controlled observation SETTING： Department of Neurology, General Hospital of Shenyang Military Area Command of Chinese PLA PARTICIPANTS： Sixty patients with ischemic stroke were selected from Neurological Department of General Hospital of Shenyang Military Area Command of Chinese PLA from January to June 2003. All cases were diagnosed with clinical diagnosis criteria of ischemic stroke established by the Fourth Chinese Classification of Cerebrovasular Disease and CT examination and received neuromuscular electric stimulation （NES）. Patients were randomly divided into control group and treatment group with 30 in each group. METHODS： Control group： Patients received routinely neurological therapy. Treatment group： Except routine therapy, patients suffered from NES at 48 hours after hospitalization. NMT-91 NES equipment was used to stimulated injured limbs with low frequency once 30 minutes a day in total of 10 times a course, especially extensor muscle of upper limb and flexor muscle of lower limb. Prescription of hemiplegia was internally decided by equipment with the output frequency of 200 Hz. Intensity of electric output could cause muscle contraction. The therapy needed two or three courses. Temperature of bilateral axilla was measured every day to calculate the difference with the formula of （temperature of axilla on the injured side - temperature of axilla on the healthy side）. Motor function of limbs was measured with FugI-Meyer Motor Assessment （FMA） during hospitalization and at 2 and 4 hours after hospitalization. Among 90 points, upper and lower limb function was 54, equilibrium function 10, sensory function 10, and motion of joint 16. The higher the scores were, the better the function was. Correlation of data was dealt with linear correlation analysis. MAIN OUTCOME MEASURES ： Assessment and correlation between difference in temperature of axilla and motor function of injured limbs during hospitalization and at 2 and 4 weeks after hospitalization. RESULTS： All 60 patients with ischemic stroke were involved in the final analysis. ① Difference in temperature： Difference of 2 and 4 weeks after hospitalization was lower than that in control group and at just hospitalization [treatment group： （0.056±0.000）, （0.024±0.003） ℃; control group： （0.250±0.001）, （0.131 ±0.001）℃; hospitalization; （0.513±0.001） ℃, P 〈 0.05-0,01]. ② FMA scores： Scores of 2 and 4 weeks after hospitalization were higher than those in control group and at just hospitalization [treatment group; （43.50±15.09）, （67.97 ±18.21） points; control group： （33.33 ±13.54）, （40.87±19.34） points; hospitalization： （26.43 ±11.87） points, P 〈 0.05-0.01]. ③ Correlation： Difference in temperature of axilla was negative correlation with FMA scores （c=- -0.255 1, P 〈 0.05）. CONCLUSION： ① PNES can accelerate recovery of limb function and decrease temperature of axilla of patients with ischemic stroke. ② The lower the difference in temperature is, the better the functional recovery is.

NEURON-SPECIFIC ENOLASE IN PATIENTS WITH ACUTE ISCHEMIC STROKE AND RELATED DEMENTIA

Neuron-specific enolase (NSE) levels of cerebrospinal fluid (CSF) were measured in 39 patients with ischemic stroke and 15 controls. There was a significant increase of CSF NSE in acute ischemic stroke patients as compared with the controls. The altered CSF NSE levels correlated well with the infarct size in CT scan. The CSF NSE levels were higher in 6-multiinfarct dementia (MID) patients who were diagnosed after 6-month follow-up than those in 22 non-MID patients of this series. Our research supports the view that CSF NSE can be a useful biochemical marker for brain ischemia. The importance of CSF NSE in the study of dementia related to ischemic stroke is worth further studies.

Factors associated with early neurological deterioration after intravenous thrombolysis with alteplase in patients with acute ischemic stroke

Objective To investigate the risk factors of early neurological deterioration(END)after intravenous thrombolysis(IVT)in patients with acute ischemic stroke(AIS).Methods We screened consecutive AIS patients from January 2006 to May 2015 in Tangshan Gongren Hospital.In this study,all patients were treated with in-

The effects of enhanced external counterpulsation on the serum level of C-reactive protein and endothelin-1 in patients with ischemic stroke

Objective To explore the effects of enhanced external counterpulsation(EECP)on the serum level of C-reactive protein and endothelin-1 in patients with cerebral ischemic stroke,to provide clinical evidence for the treatment and secondary prevention of patients with serebral ischemic stroke.Methods Total 187 patients with ischemic stroke and enrolled measure the serum level

The clinical and imaging features of 118 patients with spontaneous cerebral arterial dissections presenting with ischemic stroke

Objective To investigate the clinical and radiologic features of patients with spontaneous cerebral arterial dissections(CADs)presenting with ischemic stroke and to explore the effect of gender and age on those features.Methods Patients admitted to our stroke center diagnosed as ischemic stroke secondary to CADs from August 2008to April 2015 were prospectively registered.