Cerebral small vessel disease refers to a group of pathological processes, neuroimaging features, and clinical symptoms, with various etiologies that affect the small arteries, arterioles, venules, and capillaries of the brain. The onset of cerebral small vessel disease can be insidious. It has various symptoms, some of which can attack acutely. Acute cerebral small vessel disease is characterized by lacunar stroke and brain parenchymal hemorrhage. The latter mainly includes hypertensive hemorrhage and cerebral amyloid angiopathy. This article summarizes the research advances of acute cerebral small vessel disease from the aspects of pathogenesis, clinical manifestations, neuroimaging features, and treatment methods, discussing characteristics and clinical challenges.
ObjectiveTo conduct an objective record of stroke patient’s retinal diseases by retinal photography, and analyze the incidence of various retinal diseases between different subtypes of stroke.MethodsFrom June to October 2007, the consecutive cases of stroke admitted to the Department of Neurology, West China Hospital of Sichuan University were prospectively registered. Ischemic stroke patients were classified into different subtypes by the Oxfordshire Community Stroke Project criteria, and intracerebral hemorrhage (ICH) patients were classified based on the clinical manifestation and neuroimaging. We collected other clinical data associated with the incidence of stroke. The retinal abnormalities including retinopathy, arteriovenous nicking and arteriolar narrowing were recorded. Multivariate logistic regression was performed to investigate the relationship between retinal abnormalities and stroke.ResultsThis study included 199 patients with ischemic stroke and 95 patients with ICH. Among the patients with ischemic stroke, 43 (21.6%) had retinopathy, 52 (26.1%) presented with arteriovenous nicking, and 43 (21.6%) developed arteriolar narrowing. Among the patients with ICH, retinopathy occurred in 23 (24.2%), arteriovenous nicking occurred in 14 (14.7%), and arteriolar narrowing occurred in 25 (26.3%). In multivariate analysis, retinopathy was independently associated with partial anterior circulation infarct (PACI) (P=0.029) and anterior ICH (P=0.041).ConclusionsRetinopathy is independently associated with PACI and anterior ICH. Further community-based study with large sample should be conducted to confirm the predictive value of retinal diseases on the incidence of anterior stroke.
ObjectiveTo explored the accuracy and effectiveness of “swimming pool” sign in recognizing fluid attenuated inversion recovery sequence (FLAIR) compared with traditional methods, and to solve the difficulties in distinguishing T1 weighted image (TIWI) and FLAIR in clinical medical students and junior residents. Methods Using the observational research method, forty standardized training physicians who rotated in the Department of Neurology, West China hospital of Sichuan University were included as the research objects between September and November 2021. Standardized training physicians were randomly divided into “swimming pool” sign group and control group, with 20 persons in each group. In the same period, 100 patients with central nervous system infection, cerebral vascular disease, dementia syndrome, multiple sclerosis and no obvious intracranial lesions were selected from the Department of Neurology, West China Hospital of Sichuan University between September and November 2021. According to the diagnosis, the patients were divided into 5 groups with 20 cases in each group. Two groups were given the same 20 images respectively, including T1WI and FLAIR. Record the accuracy, total time-consuming and time-consuming per image of each standardized training physicians. Results Each patient had “swimming pool” sign. Under different backgrounds, the accuracy of the “swimming pool” sign group was higher than that of the control group (P<0.001), while the total time-consuming and time-consuming per image were lower than that of the control group (P<0.001). Conclusions In different nervous system diseases, “swimming pool” sign is stable on FLAIR. Compared with traditional methods, “swimming pool” sign can quickly and accurately distinguish T1WI and T2 FLAIR.