ObjectiveTo investigate the association between the imaging markers of ischemic cerebral small vessel disease and the occurrence of large hemispheric infarction (LHI).MethodsWe consecutively enrolled the patients with cerebral infarction in the middle cerebral artery blood supply area who admitted to the Department of Neurology, West China Hospital, Sichuan University between January 1st, 2015 and March 30th, 2016, and underwent head CT/MRI scans within one month of onset. LHI was defined as: the hypodensity was larger than 1/2 of the blood supply area of middle cerebral artery or more than 1/3 of the cerebral hemisphere within 6 hours on head CT at admission, or the infarction area was larger than 2/3 of the ipsilateral hemisphere on head MRI at admission. The basic clinical data and imaging data were collected, and the independent predictors of LHI and its independent correlation with ischemic cerebrovascular disease were explored by univariate and multivariate analyses.ResultsA total of 503 patients were included, 111 (22.1%) with LHI and 392 (77.9%) with non-LHI. Compared with the non-LHI patients, the LHI patients had a lower prevalence of white matter lesions, a lower Fazekas score, a lower prevalence of Fazekas score > 1, a lower prevalence of lacunae, a lower proportion of diabetes mellitus, a higher atrial fibrillation proportion of history, a shorter time from onset to treatment, a higher National Institute of Health Stroke Scale (NIHSS) score at admission, and a lower Glasgow Coma scale score; the distributions of TOAST types and locations of vascular stenosis were different (P<0.05). Multivariate analyses showed that white matter lesions [odds ratio (OR)=0.182, 95% confidence interval (CI) (0.050, 0.660), P=0.010], higher Fazekas score [OR=0.770, 95% CI (0.611, 0.970), P=0.027], and Fakazes score > 1 [OR=0.490, 95%CI (0.259, 0.928), P=0.029] were independent protective factors of LHI, while lacunae was not an independent factor of LHI [OR=0.583, 95% CI (0.265, 1.279), P=0.178]. Higher NIHSS score and history of atrial fibrillation were independent risk factors for LHI (P<0.001).ConclusionsThe occurrence and severity of white matter lesions (higher Fazekas score and Fazekas score > 1) are more in non-LHI group, and are independently related to the occurrence of LHI. The results suggest that ischemic preconditioning may have a protective effect on brain.
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 explore the relationship of platelet-activating factors and vascular endothelial activity markers to lacunar infarction (LI).MethodsA total of 100 inpatients diagnosed with LI in Shaanxi Provincial People’s Hospital between March 2018 and February 2019 were included, and 100 matched healthy controls were collected. Basic information, clinical baseline data, laboratory examinations, cerebral MRI and treatment data were collected after admission. The platelet-activating factors (platelet membrane glycoprotein Ⅱb/Ⅲa receptor and P-selectin) and vascular endothelial activity markers [von Willebrand factor (vWF), homocysteine (HCY), and high-sensitivity C-reactive protein (hsCRP)] levels of patients with LI were detected one month and three months after onset, and those of the control group were decteted when they were selected. SPSS 25.0 software was used for statistical analysis.ResultsAt one month after onset, there was no statistically significant difference in the levels of platelet activating factors between the LI group and the control group [platelet membrane glycoprotein Ⅱb/Ⅲa receptor: (2.84±1.00)% vs. (2.59±0.96)%, P=0.065; P-selectin: (3.05±0.63)% vs. (2.98±0.59)%, P=0.419], while the differences in the levels of vascular endothelial activity markers between the two groups were statistically significant [vWF: (141.80±17.60) vs. (124.63±10.65) ng/mL, P<0.001; hsCRP: (5.53±1.37) vs. (2.17±0.55) mg/L, P<0.001; HCY: (18.76±4.07) vs. (15.81±2.63) mmol/L, P<0.001]. At three months after onset, 94 LI patients were followed up. The levels of vWF and hsCRP between the 100 patients one month after onset and the 94 patients three months after onset were statistically different [(vWF: (141.80±17.60) vs. (134.86±13.35) ng/mL, P=0.002; hsCRP: (5.53±1.37) vs. (2.63±0.55) mg/L, P<0.001], but there was no statistically significant difference between the two time points in the levels of HCY or platelet-activating factors (P>0.05).ConclusionChronic platelet activation may not play a core role in LI pathophysiology, and endothelial dysfunction may be one of the pathological mechanisms of LI.
ObjectiveTo systematically review the association between migraine and lacunar infarcts on MR image.MethodsPubMed, EMbase, The Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials, cohort studies and cross-sectional studies on the association between migraine and lacunar infarcts from inception to March 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 5 studies involving 5 104 participants were included. The results of meta-analysis showed that: there were no significant associations of migraine (OR=0.93, 95%CI 0.78 to 1.12, P=0.470) and aura (OR=1.10, 95%CI 0.89 to 1.36, P=0.390) with lacunar infarcts on MR image. Subgroup analysis by age, presence or absence of aura showed no significant tendency.ConclusionsThere is no significant relationship between migraine and lacunar infarcts. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Cerebral small vessel disease is a common neurological disease, including acute and non-acute categories. With the development of neuroimaging, cerebral small vessel disease has attracted substantial attention in recent years. However, the categories and concepts of cerebral small vessel disease and the related imaging markers usually confuse people. The purpose of this study was to discuss the relationships among acute and non-acute cerebral small vessel disease and the imaging markers, so as to improve the understanding of cerebral small vessel disease, and to shed light on clinical practice and research.
Objective To explore the predictive value of superoxide dismutase (SOD) and serum amyloid A (SAA) in short-term poor prognosis in patients with lacunar infarction. Methods The clinical data of 185 patients who were diagnosed with lacunar infarction in the Second Affiliated Hospital of Wannan Medical College between January 1st and December 31st, 2021 were analyzed retrospectively. According to the modified Rankin Scale (mRS) score 3 months after discharge, the patients were divided into the good prognostic group (mRS≤2) and the poor prognostic group (mRS>2). Multiple logistic regression was used to analyze the independent risk factors of the short-term adverse prognosis of patients with lacunar infarction, and a risk prediction model (nomograph) was constructed. The predictive efficacy of SOD, SAA and nomograph for poor prognosis was analyzed by using the receiver operating characteristic curve. Calibration curve and decision curve analysis were used to evaluate the differentiation and clinical application value of the model. Results A total of 185 lacunar cerebral infarction patients with a mean age of (68.26±10.77) years were enrolled in this study, among whom 80 (43.2%) were males and 39 (21.1%) had adverse prognosis. Multiple logistic regression analysis showed that systolic blood pressure [odds ratio (OR)=1.028, 95% confidence interval (CI) (1.004, 1.052), P=0.021], diabetes [OR=4.939, 95%CI (1.703, 14.320), P=0.003], SAA [OR=1.089, 95%CI (1.052, 1.128), P<0.001], apolipoprotein B [OR=7.647, 95%CI (2.186, 26.753), P=0.001] were independent risk factors for poor prognosis in lacunar infarction patients, while the level of SOD [OR=0.979, 95%CI (0.965, 0.994), P=0.006] was a protective factor. The area under the curve of the nomograph for predicting the short term poor prognosis was 0.874 [95%CI (0.812, 0.936), P<0.001]. The goodness-of-fit test with the calibration curve indicated that the prediction probability was consistent with the actual occurrence probability (Hosmer-Lemeshow test P=0.295), and the decision curve indicated that the nomograph had good clinical application value. Conclusion SAA and SOD have good predictive value for short-term adverse prognosis of lacunar cerebral infarction patients, and the nomograph constructed based on them has a good differentiation and consistency, which can provide a basis for clinicians to evaluate the prognosis of lacunar cerebral infarction patients.