Use of MLC901 in cerebral venous sinus thrombosis:Three case reports

BACKGROUND Cerebral venous sinus thrombosis(CVT)is rare cause of cerebrovascular disease.The incidence is 0.5%of all stroke.The majority of affected patients are young adults(mean age:35-40 years)with mild to moderate disabilities.Poor outcome with severe disability is seen in 13%of cases.Early diagnosis and treatment are important for good outcomes and preventing complications.Treatment options are limited and mostly based on consensus.NeuroAiD II™(MLC901;Moleac Pte,Ltd,Singapore)has a potential beneficial role in post-stroke recovery,by aiding the natural brain recovery process.CASE SUMMARY MLC901 consists of nine natural herbal ingredients.Studies have shown its safety profile and aid in post stroke recovery.The aim of this case series was to demonstrate the potential role of MLC901 in stroke recovery of patients with cerebral venous sinus thrombosis(CVST)who received MLC901 in addition to standard of care.The prescribed dose of MLC901 is 400 mg/cap two capsules,three times a day.Data from these patients were prospectively collected at baseline and at monthly visits,for a duration of 3 mo.Outcome measures included adherence to therapy,side effects,National Institutes of Health Stroke Scale,Glasgow Coma Scale,modified Rankin Scale,and the Short Orientation-Memory-Concentration Test.MLC901 was well tolerated and no side effects were reported.All patients were stable with improved condition.CONCLUSION This case series highlights the potential therapeutic effects of MLC901 on CVST and provides support for further studies.

Magnetic resonance imaging combined with serum endolipin and galactagoglobin-3 to diagnose cerebral infarction in the elderly with diabetes mellitus

BACKGROUND Magnetic resonance imaging(MRI)combined with serum endothelin and galactagoglobin-3(Gal-3)can improve the clinical diagnosis of diabetes mellitus complicated with cerebral infarction.AIM To analyze the clinical value of MRI combined with serum endolipin and Gal-3 for the diagnosis of cerebral infarction in the elderly with diabetes mellitus.METHODS One hundred and fifty patients with acute cerebral infarction hospitalized between January 2021 and December 2023 were divided into two groups according to comorbid diabetes mellitus,including 62 and 88 cases in the diabetic and nondiabetic cerebral infarction groups.Serum samples were collected to detect the expression of serum endolipoxins,and Gal-3,and cranial MRI was performed at admission.Differences between the two groups were compared to analyze the diagnostic value of these parameters.RESULTS Serum endolipin and Gal-3 expression were higher in the diabetic cerebral infarction group(P<0.05).The arterial wall area,vessel area,normalized wall index,and lumen stenosis rate were higher in the diabetic cerebral infarction group,while the rate of arterial lumen moderate and severe stenosis was 48.39% higher(36.36%,P<0.05).The percentage of large(29.03%)and multiple infarcts(33.87%)in the diabetic cerebral infarction group was higher(13.64% and 20.45%),and the incidence rate of lacunar infarcts was lower(37.10%vs 65.91%)(P<0.05).The total incidence of arterial plaque in patients in the diabetic cerebral infarction group was 96.77% higher(69.32%),while the incidence of necrotic lipid core plaque was 58.06%higher(26.14%)(P<0.05).Receiver operating characteristic curve analysis was performed to assess the diagnosis utility of these techniques.MRI in combination with serum endoglin and Gal-3 had the highest area under the curve,the Yoden index,sensitivity and specificity(P<0.05).CONCLUSION The expression of serum endolipin and Gal-3 in elderly patients with diabetes mellitus with cerebral infarction showed an elevated trend,and the degree of luminal stenosis was severe.MRI predominantly revealed large and multiple infarct foci.This combined index examination can improve the clinical diagnosis of diabetes mellitus combined with cerebral infarction.

Therapeutic effect and psychological impact of aspirin plus edaravone on patients with cerebral infarction

BACKGROUND Cerebral infarction(CI)is characterized by a high prevalence,disability,and mortality.Timely or improper treatment greatly affects patient prognosis.AIM To explore the drug efficacy of aspirin plus edaravone and to explore their effect on quality of life(QOL),anxiety and depression in CI patients.METHODS We retrospectively analyzed the records of 124 CI patients treated between June 2019 and February 2021 who were assigned to an observation group(OG)(combination therapy of aspirin and edaravone,65 patients)or a control group(CG)(aspirin monotherapy,59 patients).The therapeutic effects,pre-and posttreatment National Institutes of Health Stroke Scale(NIHSS)scores,activities of daily living,degree of cognitive impairment,protein levels of glial fibrillary acidic protein(GFAP),neuron-specific enolase(NSE)and S-100B,occurrence of adverse reactions,and serum high-sensitivity C-reactive protein(hs-CRP),interleukin(IL)-6 and tumor necrosis factor(TNF)-αwere evaluated,detected and compared between the two groups.Finally,posttreatment QOL,anxiety,and depression were assessed by the Medical Outcomes Study 36-Item Short Form Health Survey Scale,Self-rating Depression Scale(SDS),and Self-rating Anxiety Scale(SAS),respectively.RESULTS Compared with the CG,the OG had markedly better therapeutic effects,greater improvements in activities of daily living,and better alleviation in cognitive dysfunction after treatment,as well as lower posttreatment NIHSS scores and serum NSE,GFAP,S-100B,hs-CRP,IL-6,and TNF-αlevels;the OG was similar to the CG in terms of adverse reactions but was better than the CG in terms of posttreatment QOL;and the OG also had lower SDS and SAS scores than the CG after treatment.CONCLUSION Aspirin plus edaravone had a good curative effect on CI.It can reverse cranial nerve damage in patients,improve neurological function and prognosis,and alleviate inflammation,anxiety,and depression;thus,it is considered safe and worthy of clinical application.

Left ventricular thrombosis caused cerebral embolism during venoarterial extracorporeal membrane oxygenation support: A case report

BACKGROUND Venoarterial(VA)extracorporeal membrane oxygenation(ECMO),an effective short-term circulatory support method for refractory cardiogenic shock,is widely applied.However,retrospective analyses have shown that VA-ECMO-assisted cases were associated with a relatively high mortality rate of approximately 60%.Embolization in important organs caused by complications of left ventricular thrombosis(LVT)during VA-ECMO is also an important reason.Although the incidence of LVT during VA-ECMO is not high,the consequences of embolization are disastrous.CASE SUMMARY A 37-year-old female patient was admitted to hospital because of fever for 4 d and palpitations for 3 d.After excluding the diagnosis of coronary heart disease,we established a diagnosis of“clinically explosive myocarditis”.The patient still had unstable hemodynamics after drug treatment supported by VA-ECMO,with heparin for anticoagulation.On day 4 of ECMO support,a left ventricular thro-mbus attached to the papillary muscle root of the mitral valve was found by transthoracic echocardiography.Left ventricular decompression was performed and ECMO was successfully removed,but the patient eventually died of multiple cerebral embolism.CONCLUSION LVT with high mobility during VA-ECMO may cause embolism in important organs.Therefore,a"wait and see"strategy should be avoided.

Clinical value of precise rehabilitation nursing in management of cerebral infarction

BACKGROUND Cerebral infarction,previously referred to as cerebral infarction or ischemic stroke,refers to the localized brain tissue experiencing ischemic necrosis or softening due to disorders in brain blood supply,ischemia,and hypoxia.The precision rehabilitation nursing model for chronic disease management is a continuous,fixed,orderly,and efficient nursing model aimed at standardizing the clinical nursing process,reducing the wastage of medical resources,and improving the quality of medical services.AIM To analyze the value of a precise rehabilitation nursing model for chronic disease management in patients with cerebral infarction.METHODS Patients(n=124)admitted to our hospital with cerebral infarction between November 2019 and November 2021 were enrolled as the study subjects.The random number table method was used to divide them into a conventional nursing intervention group(n=61)and a model nursing intervention group(n=63).Changes in the nursing index for the two groups were compared after conventional nursing intervention and precise rehabilitation intervention nursing for chronic disease management.RESULTS Compared with the conventional intervention group,the model intervention group had a shorter time to clinical symptom relief(P<0.05),lower Hamilton Anxiety Scale and Hamilton Depression Scale scores,a lower incidence of total complications(P<0.05),a higher disease knowledge mastery rate,higher safety and quality,and a higher overall nursing satisfaction rate(P<0.05).CONCLUSION The precision rehabilitation nursing model for chronic disease management improves the clinical symptoms of patients with cerebral infarction,reducing the incidence of total complications and improving the clinical outcome of patients,and is worthy of application in clinical practice.

Effect of alteplase thrombolysis sequenced by low molecular heparin calcium antithrombosis on the neurological function and serum cytokines in patients with cerebral infarction

Objective:To study the effect of alteplase thrombolysis sequenced by low molecular heparin calcium antithrombosis on the neurological function and serum cytokines in patients with cerebral infarction.Methods:Patients with acute cerebral infarction who received alteplase thrombolysis in Zigong Fourth People's Hospital between June 2014 and October 2016 were retrospectively analyzed and divided into the intervention group who received low molecular heparin calcium treatment and the control group who did not receive low molecular heparin calcium treatment. The serum was collected before and after treatment to determine the contents of platelet activation factors, nerve injury molecules, soluble apoptotic molecules and growth factors.Results: Serum CD62p, CD63, PAF, GMP-140, NSE, S100B, GFAP, sFas, sFasL, sTRAIL, IGF-1, VEGF, BDNF and bFGF levels of both groups of patients after treatment were lower than those before treatment, serum CD62p, CD63, PAF, GMP-140, NSE, S100B, GFAP, sFas, sFasL and sTRAIL levels of intervention group after treatment were lower than those of control group while IGF-1, VEGF, BDNF and bFGF levels were higher than those of control group.Conclusion: Alteplase thrombolysis sequenced by low molecular heparin calcium antithrombosis for acute cerebral infarction can inhibit platelet activation and cell apoptosis, alleviate nerve injury and improve neurotrophy status.

Application Effect of Early Rehabilitation Nursing in Elderly Cerebral Infarction Patients with Dysphagia

Objective:To observe the application effect of early rehabilitation nursing in elderly cerebral infarction patients with dysphagia.Methods:120 cases of elderly cerebral infarction patients with dysphagia were divided into 60 cases in the control group and 60 cases in the observation group by the double-blind method,and conventional nursing and early rehabilitation nursing were implemented respectively.Swallowing function,quality of life,adverse events,and nursing satisfaction were compared before and after nursing care.Results:After nursing,the swallowing function score of the observation group(1.01±0.18 points)was lower than that of the control group,and the quality of life score(160.63±9.95 points)was higher than that of the control group(P<0.05);the incidence rates of aspiration and aspiration pneumonia in the observation group(5.00%and 3.33%)were lower than that of the control group(P<0.05);the total nursing satisfaction of the observation group(98.33%)was higher than that of the control group(P<0.05).Conclusion:Early rehabilitation nursing can reduce the degree of dysphagia in elderly patients with cerebral infarction,reduce the incidents of aspiration and aspiration pneumonia,and improve the quality of life,with high nursing satisfaction.

The Effect of Different Hyperbaric Oxygen Treatment Time Windows on Neurological Function and Prognosis in Acute Cerebral Infarction

Objective:To observe the effects of different hyperbaric oxygen treatment time windows on the prognosis and neurological function of acute cerebral infarction.Method:160 patients with acute cerebral infarction admitted to Xiangyang Central Hospital in Hubei Province were randomly divided into four groups,each with 40 cases,using a random number table method.According to the 2017 guidelines for the treatment of cerebral infarction,the control group received routine treatment for acute cerebral infarction;On the basis of the control group,patients in Group A received hyperbaric oxygen therapy within 48 hours of onset;Group B patients receive hyperbaric oxygen therapy within 3-6 days of onset;Group C patients receive hyperbaric oxygen therapy within 7-12 days of onset.Observe the efficacy,recurrence,and neurological function recovery of four groups of patients after treatment.Result:There was no statistically significant difference in the National Institutes of Health Stroke Scale(NIHSS)and Barthel Index(BI)scores among the four groups before treatment(P>0.05).There were statistically significant differences in NIHSS and BI scores between 14 and 30 days after treatment and before treatment(F=16.352,27.261,11.899,28.326,P<0.05).At 14 and 30 days after treatment,the NIHSS score in Group A decreased compared to the control group,Group B,and Group C,while the BI score increased compared to the control group,Group B,and Group C,with statistical significance(P<0.05).There was no statistically significant difference in NIHSS and BI scores between Group C and the control group after treatment(P>0.05).After 30 days of treatment,the total effective rate of Group A was higher than that of the control group and Group C,and the difference was statistically significant(X2=6.135,P<0.05).The one-year recurrence rate of Group A and Group B is lower than that of Group C and the control group,and the difference is statistically significant(X2=8.331,P<0.05).There was no statistically significant difference in adverse reactions among the four groups(P>0.05).Conclusion:Patients with acute cerebral infarction who receive hyperbaric oxygen therapy within 48 hours can improve neurological function and reduce the recurrence rate.The efficacy of receiving hyperbaric oxygen therapy within 7-12 days of onset is equivalent to that of not receiving hyperbaric oxygen therapy.

Analysis of the Effect of Limb Rehabilitation Therapy Combined with Transcranial Magnetic Stimulation Therapy on Muscle Activity in Patients with Upper Limb Dysfunction After Cerebral Infarction

Objective:To analyze the effect of limb rehabilitation therapy combined with transcranial magnetic stimulation therapy on muscle activity in patients with upper limb dysfunction after cerebral infarction(CI).Methods:320 patients with upper limb dysfunction after CI were selected,all of whom were treated in our hospital between June 2021 and June 2023.They were randomly grouped according to the lottery method into the control group(limb rehabilitation therapy,160 cases)and the intervention group(transcranial magnetic stimulation therapy+limb rehabilitation therapy,160 cases).The upper limb function scores,neuro-electrophysiological indicators,daily living ability scores,and quality of life scores of the two groups were compared.Results:Compared with the control group,upper limb function scores and daily living ability scores in the intervention group were higher after treatment,and the neuro-electrophysiological indicators of the intervention group were lower after treatment(P<0.05).Conclusion:Transcranial magnetic stimulation therapy combined with limb rehabilitation therapy has significant effects in patients with upper limb dysfunction after CI and is worthy of promotion and application.

The Prognostic Value of Red Cell Distribution Width in Critically Ill Cerebral Infarction Patients:A Retrospective Cohort Study

Objective:Red blood cell distribution width(RDW)has been utilized as a prognostic indicator for mortality risk assessment in cardiovascular and cerebrovascular patients.Nevertheless,the prognostic significance of RDW in critically ill patients with cerebral infarction is yet to be investigated.The objective of this study is to examine the association between RDW and the risk of all-cause mortality in cerebral infarction patients admitted to the intensive care unit(ICU).Method:A retrospective cohort study was conducted using the Medical Information Mart for Intensive Care IV 2.2(MIMIC-IV)intensive care dataset for data analysis.The main results were the all-cause mortality rates at 3 and 12 months of follow-up.Cumulative curves were plotted using the Kaplan-Meier method,and Cox proportional hazards analysis was used to examine the relationship between RDW and mortality rates in critically ill cerebral infarction patients.Results:The findings indicate that RDW serves as a significant prognostic factor for mortality risk in critically ill stroke patients,specifically at the 3 and 12-month follow-up periods.The observed correlation between increasing RDW levels and higher mortality rates among cerebral infarction patients further supports the potential utility of RDW as a predictive indicator.Conclusion:RDW emerges as an independent predictor of mortality risk during the 3 and 12-month follow-up periods for critically ill patients with cerebral infarction.

Common carotid artery thrombosis and malignant middle cerebral artery infarction following ovarian hyperstimulation syndrome:A case report

BACKGROUND Arterial thrombosis is a serious and rare complication of ovarian hyperstimulation syndrome(OHSS).Herein,we describe a case of OHSS complicated by common carotid artery thrombosis and malignant middle cerebral artery infarction after egg retrieval and before embryo transfer.CASE SUMMARY A 32-year-old female with a family history of thrombosis who was undergoing in vitro fertilization due to unexplained infertility,was admitted due to abdominal distension for 3 d and coma for 2 h.She received egg retrieval 7 d ago and embryo transfer had not yet been performed.Blood biochemical analysis showed estrogen of 15781 pmol/L.Gynecological examination showed palpable masses on both sides of the adnexal areas.Ultrasound observed enlarged ovaries and abdominal ascites.Imaging examination of the head and neck revealed fresh malignant middle cerebral artery infarction in the left side of brain and internal carotid artery as well as occlusion in the left carotid artery,internal carotid artery,and middle cerebral artery.The patient was finally diagnosed with severe OHSS,complicated by common carotid artery thrombosis and malignant middle cerebral artery infarction.Liquid replacement,anticoagulation,vascular endothelium protection,brain protection and decompressive craniectomy were carried out.Rehabilitation training was then performed for 6 mo.At present,she has poor speaking ability and decreased muscle strength on the right side.CONCLUSION There is a risk of thrombosis during any period of OHSS.During in vitro assisted reproduction,for cases with a family history of thrombosis,hyperlipidemia and other high-risk factors,serum lipid levels should be controlled as soon as possible to improve metabolic dysfunction.When thrombosis occurs,timely and effective treatment should be performed to improve the prognosis.

Application of a hospital–community–family trinity rehabilitation nursing model combined with motor imagery therapy in patients with cerebral infarction

BACKGROUND Rehabilitation nursing is considered an indispensable part of the cerebral infarction treatment system.The hospital–community–family trinity rehabilitation nursing model can provide continuous nursing services across hospitals,communities,and families for patients.AIM To explore the application of a hospital–community–family rehabilitation nursing model combined with motor imagery therapy in patients with cerebral infarction.METHODS From January 2021 to December 2021,88 patients with cerebral infarction were divided into a study(n=44)and a control(n=44)group using a simple random number table.The control group received routine nursing and motor imagery therapy.The study group was given hospital–community–family trinity rehabilitation nursing based on the control group.Motor function(FMA),balance ability(BBS),activities of daily living(BI),quality of life(SS-QOL),activation status of the contralateral primary sensorimotor cortical area to the affected side,and nursing satisfaction were evaluated before and after intervention in both groups.RESULTS Before intervention,FMA and BBS were similar(P>0.05).After 6 months’intervention,FMA and BBS were significantly higher in the study than in the control group(both P<0.05).Before intervention,BI and SS-QOL scores were not different between the study and control group(P>0.05).However,after 6months’intervention,BI and SS-QOL were higher in the study than in the control group(P<0.05).Before intervention,activation frequency and volume were similar between the study and the control group(P>0.05).After 6 months’intervention,the activation frequency and volume were higher in the study than in the control group(P<0.05).The reliability,empathy,reactivity,assurance,and tangibles scores for quality of nursing service were higher in the study than in the control group(P<0.05).CONCLUSION Combining a hospital–community–family trinity rehabilitation nursing model and motor imagery therapy enhances the motor function and balance ability of patients with cerebral infarction,improving their quality of life.

Efficacy and Safety of Ginkgo Biloba Tincture(银杏叶酊) Combined with Conventional Medication in the Treatment of Cerebral Infarction: Systematic Review and Meta-analysis

Objective:To analyze the efficacy and safety of Ginkgo biloba tincture combined with conventional medication in the treatment of cerebral infarction by systematic evaluation.Methods:Searched the randomized controlled trials of Ginkgo biloba tincture in treating cerebral infarction.English literatures were searched from PubMed,EMbase,Cochrane Library and Web of Science,and Chinese literatures were searched from Chinese Biomedical Literature Database(CBM),China National Knowledge Infrastructure(CNKI),China Science and Technology Journal Database(VIP)and Wanfang Medical Database.At the same time,we searched dissertations,conference papers,and found relevant unpublished research results reports.Literature quality was evaluated using a"bias risk assessment tool"and Meta-analysis using RevMan 5.4 software(from the Cochrane Collaboration).A total of 29 literatures were retrieved,and finally 4 literatures meeting the standards were included.There were 455 samples involved,including 244 cases in the experimental group and 211 cases in the control group.Results:①Effectiveness analysis:The total effective rate of Ginkgo biloba tincture combined with routine treatment was better than that of the control group[RR=1.26,95%CI(1.07,1.47),P=0.005].The hematocrit of Ginkgo biloba tincture combined with conventional treatment was significantly better than that of conventional treatment alone(P<0.05),The neurological deficits of Ginkgo biloba tincture combined with routine therapy was significantly improved(P<0.05).After Ginkgo biloba tincture combined with conventional therapy,the scores of mini-mental state examination(MMSE),activity daily living scale(ADL)and MOSSF-36 quality of life scale were significantly better than those of the control group(P<0.05).②Safety analysis:3 articles reported the safety of medication.There was no obvious change in blood routine,liver and kidney function results and no adverse reactions in the experimental group and the control group.Conclusion:The above results indicated that Ginkgo biloba tincture combined with conventional treatment can improve the total effective rate of patients with cerebral infarction,and it is safe and has no adverse reactions.However,the number of literatures included in this study is small,and the quality of controlled trials is not good.It is still necessary to adopt clinical controlled trials with reasonable design,outcome indicators in line with international social norms and large sample content to further improve the evidence level of clinical research.

A Case of Acute Upper Gastrointestinal Bleeding in Liver Cirrhosis Complicated by Acute Cerebral Infarction and Acute Myelitis

Background: Acute upper gastrointestinal bleeding in liver cirrhosis combined with acute cerebral infarction is uncommon in clinical work, and then combined with acute myelitis is even rarer and more complex, which poses a greater challenge to clinical diagnosis and treatment. This paper reports a case of acute upper gastrointestinal bleeding in liver cirrhosis complicated by acute cerebral infarction and acute myelitis, which be hoped to provide a reference for clinical work. Methods: We retrospectively evaluated the clinical information of a 68-year-old female admitted to the Digestive Medical Department with acute gastrointestinal bleeding and appeared limb movement disorder on the third day. Results: The patient was eventually diagnosed with acute upper gastrointestinal bleeding in liver cirrhosis complicated by acute cerebral infarction and acute myelitis. Conclusions: When patients with liver cirrhosis have abnormal neurological symptoms, in addition to liver cirrhosis-related complications, doctors need to consider cerebrovascular diseases and myelitis.

Edaravone administration and its potential association with a new clinical syndrome in cerebral infarction patients:Three case reports

BACKGROUND Edaravone is a widely used treatment for patients with cerebral infarction and,in most cases,edaravone-induced side effects are mild.However,edaravone-related adverse reactions have been receiving increasing attention.CASE SUMMARY We treated three patients with acute cerebral infarction who died following treatment with edaravone.Edaravone is a widely used treatment for patients with cerebral infarction and,in most cases,edaravone-induced side effects are mild.However,edaravone-related adverse reactions have been receiving increasing attention.CONCLUSION Our cases highlight the importance of educating clinicians regarding the new edaravone-induced clinical syndromes of cerebral infarction as potentially fatal adverse drug reactions.Considering that no laboratory or confirmatory test exists to diagnose edaravone-induced death from cerebral infarction,clinicians’knowledge is the key element in recognizing this phenomenon.

Rare cause of cerebral venous sinus thrombosis:Spontaneous intracranial hypotension syndrome:A case report

BACKGROUND Spontaneous intracranial hypotension syndrome is a relatively uncommon neurological disorder of unknown etiology with a good prognosis.Cerebral venous sinus thrombosis is a specific type of cerebrovascular disease caused by multiple etiologies of cerebral venous sinus or vein thrombosis that obstructs cerebral venous return and is associated with impaired cerebrospinal fluid absorption;this entity is rarely seen clinically.Spontaneous intracranial hypotension syndrome is one of the causes of cerebral venous sinus thrombosis,and the probability of their combined occurrence is only 1%-2%.As such,it is easily overlooked clinically,thus increasing the difficulty of diagnosis and treatment.CASE SUMMARY A 29-year-old young woman presented with postural headache.Lumbar puncture suggested a pressure of 50 mmH2O(normal 80 mmH2O-180 mmH2O),and magnetic resonance imaging cerebral venography suggested thrombosis of the supratentorial sinus.These findings were considered indicative of cerebral venous sinus thrombosis due to spontaneous intracranial hypotension syndrome after ruling out immunological causes,tumor,infection,abnormal coagulation mechanism,and hypercoagulable state,etc.She was treated with rehydration and low-molecular heparin anticoagulation for 15 d,and follow-up magnetic resonance imaging cerebral venography suggested resolution of the thrombus.The patient had complete improvement of her headache symptoms.CONCLUSION Spontaneous intracranial hypotension syndrome is one of the rare causes of cerebral venous sinus thrombosis,which is frequently misdiagnosed or missed and deserves consideration by clinicians during differential diagnosis.Dehydration should be avoided in such patients,and early rehydration and anticoagulation therapy are effective treatment options.

Sneddon's syndrome concurrent with cerebral venous sinus thrombosis:A case report

BACKGROUND This report delves into the diagnostic and therapeutic journey undertaken by a patient with Sneddon's syndrome(SS)and cerebral venous sinus thrombosis(CVST).Particular emphasis is placed on the comprehensive elucidation of SS's clinical manifestations,the intricate path to diagnosis,and the exploration of potential underlying mechanisms.CASE SUMMARY A 26-year-old woman presented with recurrent episodes of paroxysmal unilateral limb weakness accompanied by skin mottling,seizures,and cognitive impairment.Digital subtraction angiography revealed CVST.Despite negative antiphospholipid antibody results,skin biopsy indicated chronic inflammatory cell infiltration.The patient was treated using anticoagulation,antiepileptic therapy,and supportive care,which resulted in symptom improvement.The coexistence of SS and CVST is rare and the underlying pathophysiology remains uncertain.This case underscores the challenge in diagnosis and highlights the need for early clinical differentiation to facilitate accurate assessment and prompt intervention.CONCLUSION This article has reported and analyzed the clinical data,diagnosis,treatment,and prognosis of a case of SS with CVST and reviewed the relevant literature to improve the clinical understanding of this rare condition.

Analysis of mental health status and related factors in patients with acute cerebral infarction

BACKGROUND Acute cerebral infarction(ACI)is characterized by a high incidence of morbidity,disability,recurrence,death and heavy economic burden,and has become a disease of concern in global researchers.As ACI has serious effects on patients’physical status,life and economy,often causing anxiety,depression and other psychological problems,these problems can lead to the aggravation of physical symptoms;thus,it is very important to understand the factors affecting the mental health of these patients.AIM To understand the elements that affect the mental health of patients who have suffered an ACI.METHODS A questionnaire survey was conducted among patients with ACI admitted to three tertiary hospitals(Quanzhou First Hospital,Fuqing City Hospital Affiliated to Fujian Medical University,and the 900 Hospital of the Joint Service Support Force of the People’s Liberation Army of China)in Fujian Province from January 2022 to December 2022 using the convenience sampling method.ACI inpatients who met the inclusion criteria were selected.Informed consent was obtained from the patients before the investigation,and a face-to-face questionnaire survey was conducted using a unified scale.The questionnaire included a general situation questionnaire,Zung’s self-rating depression scale and Zung’s self-rating anxiety scale.All questionnaires were checked by two researchers and then the data were input and sorted using Excel software.The general situation of patients with ACI was analyzed by descriptive statistics,the influence of variables on mental health by the independent sample t test and variance analysis,and the influencing factors on psychological distress were analyzed by multiple stepwise regression.RESULTS The average age of the 220 patients with ACI was 68.64±10.74 years,including 142 males and 78 females.Most of the patients were between 60 and 74 years old,the majority had high school or technical secondary school education,most lived with their spouse,and most lived in cities.The majority of patients had a personal income of 3001 to 5000 RMB yuan per month.The new rural cooperative medical insurance system had the largest number of participants.Most stroke patients were cared for by their spouses and of these patients,52.3%had previously smoked.Univariate analysis showed that gender,age,residence,course of disease,number of previous chronic diseases and smoking history were the main factors affecting the anxiety scores of patients with ACI.Age,living conditions,monthly income,course of disease and knowledge of disease were the primary variables influencing the depression score in patients with ACI.The findings of multivariate analysis revealed that the course of disease and gender were the most important factors influencing patients’anxiety scores,and the course of disease was also the most important factor influencing patients’depression scores.CONCLUSION Long disease course and female patients with ACI were more likely to have psychological problems such as a high incidence of emotional disorders.These groups require more attention and counseling.

Value of Tongue Color Combined with Sublingual Microcirculation in Predicting the Severity of Mild to Moderate Acute Cerebral Infarction

Objective:To explore the value of tongue color combined with sublingual microcirculation in predicting the severity of mild to moderate acute cerebral infarction(ACI).Methods:From January to December 2022,90 patients with ACI were admitted to the Department of Neurology of Jiangsu Provincial Hospital of Integrated Traditional Chinese and Western Medicine.According to the NHISS score on the 5th day of admission,the patients were divided into mild group(35 cases)and moderate group(55 cases).The changes of tongue color and arterial lactate on the 5th day of admission were observed and monitored.Side-stream dark field imaging(SDF)was used to determine the total vascular density(TVD),perfused vascular density(PVD),perfused vascular ratio(PPV)and microvascular flow index(MFI).The multivariate logistic regression analysis was used to screen the risk factors for the severity of ACI,and the receiver operating characteristic curve(ROC)to evaluate their values in predicting ACI severity.Results:There was no significant difference in lactate between the two groups(P>0.05),and the frequency of red tongue in the mild group was higher,and the frequency of red tongue in the moderate group was significantly higher in the dark tongue group(P<0.05).The multivariate logistic regression analysis showed that PVD and PPV were independent risk factors for the severity of mild to moderate ACI(P<0.05).The ROC curve analysis showed that an area under the curve of 0.832 was achieved by the combination of PVD and PPV,which was larger than that of a single factor.Conclusion:Tongue color combined with sublingual microcirculation can be combined to predict the severity of mild to moderate ACI.

Correlation between angiotensinogen gene and primary hypertension with cerebral infarction in the Li nationality of China

Objective To investigate the relationship of four single nucleotide polymorphism （SNP） haplotypes in the angiotensinogen （AGT） gene to the primary hypertension with or without cerebral infarction in the Li nationality of Hainan, China. Methods Total 300 subjects were allocated into three different groups： Groupl, 100 patients who have primary hypertension; Group 2, 100 patients who have primary hypertension with cerebral infarction; and control group, 100 healthy individuals. The genotypes of all subjects were determined by PCR-sequencing to analyze the four poly- morphisms at position - 152 （G-A）, -20 （A-C）, - 18 （C-T）, and -6 （A-G） in the promoter region of AGT. Results The frequen- cies ofCT genotype of AGT-18 and T allele in Group 1 （P = 0.003, P = 0.004） and Group 2 （P = 0.002, P = 0.002） were both significantly higher than in healthy controls. The frequency of G allele of AGT-6 was significantly higher in Group 2 than in the control group （P = 0.016）, while there is no significant difference between Group 1 and the control. Haplotype analysis revealed that H6 haplotype frequency which included -20C and -6G was significantly increased in Group 2 （P = 0.003） compared with the control group, while H5 haplotype frequency which included -20C and -18T was signifi- cantly increased in Group 1 （P = 0.006） versus the control. Conclusion The -20 （A-C） and - 18 （C-T） of the AGT may play an important role in pathogenesis of primary hypertension; and -20 （A-C）, -18 （C-T）, and -6 （A-G） may be the genetic risk factors for the onset of primary hypertension with cerebral infarction in the Li nationality of Halnan, China.