This case report investigates the manifestation of cerebral amyloid angiopathy (CAA) through recurrent Transient Ischemic Attacks (TIAs) in an 82-year-old patient. Despite initial diagnostic complexities, cerebral ang...This case report investigates the manifestation of cerebral amyloid angiopathy (CAA) through recurrent Transient Ischemic Attacks (TIAs) in an 82-year-old patient. Despite initial diagnostic complexities, cerebral angiography-MRI revealed features indicative of CAA. Symptomatic treatment resulted in improvement, but the patient later developed a fatal hematoma. The discussion navigates the intricate therapeutic landscape of repetitive TIAs in the elderly with cardiovascular risk factors, emphasizing the pivotal role of cerebral MRI and meticulous bleeding risk management. The conclusion stresses the importance of incorporating SWI sequences, specifically when suspecting a cardioembolic TIA, as a diagnostic measure to explore and exclude CAA in the differential diagnosis. This case report provides valuable insights into these challenges, highlighting the need to consider CAA in relevant cases.展开更多
Transient ischemic attack(TIA) is an acute cerebrovascular incident,and is generally considered the best opportunity for early neuroprotective treatment against cerebral ischemia.This study retrospectively analyzed 80...Transient ischemic attack(TIA) is an acute cerebrovascular incident,and is generally considered the best opportunity for early neuroprotective treatment against cerebral ischemia.This study retrospectively analyzed 80 patients with TIA(38 males and 42 females).Among 61 patients who received neuroprotective cerebrolysin treatment within 24 hours after TIA onset,13(21.31%) patients suffered subsequent strokes.Among 19 patients who received neuroprotective cerebrolysin treatment within 24-72 hours after TIA onset,seven(36.84%) developed cerebral infarction.There was a significant difference in the proportion of subsequent strokes between patients receiving cerebrolysin treatment within 24 hours and 24-72 hours after TIA onset(P = 0.438).These findings suggest that neuroprotective drugs administrated within 24 hours after TIA onset help reduce the incidence of subsequent strokes.The results demonstrate usefulness of the ABCD2 score at TIA patients in the determination of short-term and long-term cerebrovascular risk,including the frequency of subsequent ischemic cerebral infarctions up to 12 months.展开更多
BACKGROUND: Recent researches demonstrate that damage of executive function is an early manifestation of vascular cognitive disorder. OBJECTIVE: To investigate the executive functions of patients with transient ischem...BACKGROUND: Recent researches demonstrate that damage of executive function is an early manifestation of vascular cognitive disorder. OBJECTIVE: To investigate the executive functions of patients with transient ischemic attack (TIA). DESIGN: Case control. SETTING: Department of Neurology, the First Affiliated Hospital of Xinxiang Medical College. PARTICIPANTS: A total of 83 TIA patients (46 males and 37 females, aged 32–74 years) were selected from Department of Neurology, the First Affiliated Hospital of Xinxiang Medical College from July 2005 to December 2006. The diagnosis of TIA was established by the criteria of cerebrovascular diseases made by the Fourth National Cerebrovascular Disease Meeting. In these cases, forty-five patients (54%) were involved in internal carotid artery, and thirty-eight patients (46%) were involved in vertebral basilar system. Fifty healthy adults (Control group: 28 males and 22 females, aged 32–74 years) were chosen from retiree in community and family of patients. All of them were right-handedness, without cerebrovascular disease, cerebral trauma, inborn oligophrenia, and hearing and visual disorders; also they had no anxiety and depression nearly one week. In addition, all the subjects cooperated with examination. METHODS: After TIA diagnosis, all patients received neuropsychological examination, including attention and inhibition, working memory, flexibility, planning and diversion, based on Stroop tests (C and CW) and the Wisconsin card sorting tests (WCST). ① WCST test: The edition revised by Nelson was used. We would take the times of sorting, incorrect response, persistent incorrect response, and randomly incorrect response as the index of evaluation. ② Stroop tests: The edition revised by Trenarry was used and this test had two types: form color and form color-word. Their incorrect response and response time were recorded for data analysis in the end. MAIN OUTCOME MEASURES: Results of WCST test and Stroop tests. RESULTS: A total of 83 TIA patients and 50 healthy subjects were involved in the final analysis. Items of Stroop tests, including response time of Stroop-C test, incorrect response of Stroop-C test, response time of Stroop-CW test and incorrect response of Stroop-CW test, and items of WCST, including incorrect response, persistent incorrect response and random incorrect response, between internal carotid artery system and vertebral basilar artery system were (93.87±24.39) s, 3.16±3.97, (228.46±68.13) s, 12.91±10.56, 55.42± 20.38, 26.58±10.41, 28.62±11.22; (96.76±24.75) s, 3.89±4.77, (223.46±72.54) s, 18.71±13.80, 52.47 ±22.25, 28.82±16.20, 23.39±9.72, respectively; this was higher than those in the control group [(52.10± 12.18) s, 1.68±1.97, (134.86±34.15) s, 4.22±4.21, 32.46±17.97, 14.42±8.47, 18.24±10.24, P < 0.05– 0.01]. Times of sorting of WCST between internal carotid artery system and vertebral basilar artery system were obviously lower than those in the control group (8.27±2.73, 8.66±2.77, 11.22±2.41, P < 0.01). However, there were no significant differences between internal carotid artery system and vertebral basilar artery system (P > 0.05). CONCLUSION: Patients with TIA have executive dysfunctions, and the dysfunctions have no difference between internal carotid artery system and vertebral basilar artery system.展开更多
BACKGROUND Cerebral ischemic stroke is attributed to paradoxical cerebral embolism.Pulmonary arteriovenous fistula(PAVF)is a rare potential cause of cerebral ischemic stroke,and cerebral ischemic stroke induced by PAV...BACKGROUND Cerebral ischemic stroke is attributed to paradoxical cerebral embolism.Pulmonary arteriovenous fistula(PAVF)is a rare potential cause of cerebral ischemic stroke,and cerebral ischemic stroke induced by PAVF in children is rare.CASE SUMMARY We report a case of right PAVF that presented as a transient ischemic attack(TIA)in a 13-year-old boy.The patient underwent embolization therapy and remained clinically stable for 2 years after treatment.CONCLUSION TIA induced by PAVF in children is rare,lacks typical clinical manifestations,and should not be ignored.展开更多
Objective:To compare the diagnostic value of the ABCD2 and ABCD3-栺scoring systems in predicting the development of a 30-day neurological event in adult patients with transient ischemic attack(TIA)presenting to the em...Objective:To compare the diagnostic value of the ABCD2 and ABCD3-栺scoring systems in predicting the development of a 30-day neurological event in adult patients with transient ischemic attack(TIA)presenting to the emergency department.Methods:The study was observational and prospective and was conducted in a single center.The diagnostic values of the ABCD2 and ABCD3-栺scores in predicting a neurological event within one month were compared in patients diagnosed with TIA in the emergency department.Results:A statistically significant difference was observed between groups with or without stroke within one month in terms of both the ABCD2 and ABCD3-栺scores(P=0.044 and P=0.029,respectively).There was no statistically significant difference between the patients with and without a recurrent TIA within one month in relation to the ABCD2 score(P=0.934),but a statistically significant difference was found in the ABCD3-栺scores of these groups(P<0.001).Conclusions:Both the ABCD2 and ABCD3-栺scoring systems could predict ischemic stroke within 30 days of TIA,the ABCD3-栺score is more effective than the ABCD2 score in the prediction of TIA recurrence.展开更多
Background Although transient ischemic attacks (TIA) is a clinical diagnosis, imaging findings are important for its diagnosis and treatment. This study evaluated the value and limitations of conventional CT, CT cereb...Background Although transient ischemic attacks (TIA) is a clinical diagnosis, imaging findings are important for its diagnosis and treatment. This study evaluated the value and limitations of conventional CT, CT cerebral perfusion imaging and transcranial Doppler sonography (TCD) in patients with TIA. Methods Conventional CT, CT cerebral perfusion imaging and TCD were performed in 20 patients with TIA. After regular CT examination, 40-second dynamic scans were performed on selected slice, while 40 ml of non-ionic contrast materials was bolus-injected through antecubital vein with power injector. These dynamic images were processed with the perfusion software package on workstation. Cerebral blood flow (CBF) and time to peak (TTP) were measured in specific regions of the brain. TCD was also performed in 20 patients with TIA. Comparative analysis was made on the basis of the results of conventional CT, CT cerebral perfusion imaging and TCD. Results In the 20 patients with TIA, conventional CT turned out to be normal. However, persisting abnormal perfusion changes corresponding to clinical symptoms were found in 13 cases with the prolonged TTP. The other 7 cases were normal. TTP of the affected side (11.6±3.0)s was significantly prolonged (t=4.782,P<0.01) in comparison with the contralateral side (8.8±1.5)s. The difference in CBF was not statistically significant (t=1.912, P=0.073) between the affected side [(223.9±19.6) ml·min-1·L-1] and the contralateral side [(227.7±19.8) ml·min-1·L-1] . TCD revealed severe stenosis or occlusion of the carotid artery in 10 patients, arteriosclerosis in 6 patients, blood speed decrease in 2 patients, vasospasm in 1 patient. Conclusions Conventional CT can exclude intracerebral diseases. Perfusion CT provides valuable hemodynamic information and shows the extent of perfusion disturbances. TCD can demonstrate abnormalities of the involved arteries in patients with TIA. The combination of these three imaging methods can provide more diagnostic information.展开更多
BACKGROUND: Due to collateral circulation and cerebrovascular reserve, arterial stenosis and reduced cerebral blood flow may not necessarily indicate impaired cerebral perfusion. Therefore, according to degree of sten...BACKGROUND: Due to collateral circulation and cerebrovascular reserve, arterial stenosis and reduced cerebral blood flow may not necessarily indicate impaired cerebral perfusion. Therefore, according to degree of stenosis and clinical symptoms, interventional surgery to relieve arterial stenosis in transient ischemic attack (TIA) patients with major intracranial stenosis is imprudent. Rather, cerebral perfusion and reserve capacity are direct indicators for the assessment of degree and presence of cerebral ischemia. OBJECTIVE: To evaluate cerebral perfusion and reserve in TIA patients with major intracranial stenosis or occlusion using magnetic resonance-perfusion-weighted imaging (MR-PWI) data prior to and following diamox administration. DESIGN, TIME AND SETTING: A self-comparative, neuroimaging observation was performed at the Neurological Department and Radiological Center of the First Affiliated Hospital of Jinan University between December 2007 and April 2009. PARTICIPANTS: Seven acute TIA patients, who were admitted to the Neurological Department of the First Affiliated Hospital of Jinan University between December 2007 and April 2009, were enrolled in the present study. Magnetic resonance imaging confirmed that no acute cerebral infarction happened, nor did bleeding exist. Magnetic resonance angiography, transcranial Doppler ultrasound, and/or digital subtraction angiography confirmed the presence of major intracranial arterial stenosis. Clinical symptoms corresponded to blood supplying regions of the arterial stenosis. METHODS: Baseline MR-PWI was performed on seven patients with intracranial stenosis or occlusion. Two grams of acetazolamide (diamox) were orally administered after 2 days. A second PWI was performed after 2 hours to compare cerebral perfusion parameters prior to and following diamox administration. MAIN OUTCOME MEASURES: PWI results of cerebral perfusion prior to and following diamox administration. RESULTS: The baseline PWI from five patients indicated decreased cerebral perfusion areas. Following oral administration of diamox, cerebral perfusion significantly decreased in those areas. Moreover, new areas of decreased cerebral perfusion were observed in two out of the five patients. In one patient, no significant decrease in cerebral perfusion was found. In another patient, baseline PWI indicated decreased cerebral perfusion in the left hemisphere. However, normal perfusion was observed in both cerebral lobes following diamox administration. CONCLUSION: TIA patients with intracranial stenosis, who are diagnosed by PWI and exhibited decreased cerebral perfusion and reserve, might require further treatment such as intervention by angioplasty.展开更多
Flavonoids are a major component in the traditional Chinese medicine Radix Ilicis Pubescentis.Previous studies have shown that the administration of Radix Ilicis Pubescentis total flavonoids is protective in cerebral ...Flavonoids are a major component in the traditional Chinese medicine Radix Ilicis Pubescentis.Previous studies have shown that the administration of Radix Ilicis Pubescentis total flavonoids is protective in cerebral ischemia.However,to our knowledge,no studies have examined whether the total flavonoids extracted from Radix Ilicis Pubescentis prevent or ameliorate neuronal damage following transient ischemic attacks.Therefore,Radix Ilicis Pubescentis total flavonoids question and the potential underlying mechanisms.Thus,beginning 3 days before the induction of a mouse model of transient ischemic attack using tert-butyl hydroperoxide injections,mice were intragastrically administered 0.3,0.15,or 0.075 g/kg of Radix Ilicis Pubescentis total flavonoids daily for 10 days.The results of spectrophotometric analyses demonstrated that Radix Ilicis Pubescentis total flavonoids enhanced oxygen free radical scavenging and reduced pathological alterations in the brain.Hematoxylin-eosin staining results showed that Radix Ilicis Pubescentis total flavonoids reduced hippocampal neuronal damage and cerebral vascular injury in this mouse model of transient ischemic attack.These results suggest that the antioxidant effects of Radix Ilicis Pubescentis total flavonoids alleviate the damage to brain tissue caused by transient ischemic attack.展开更多
BACKGROUND Early prediction of transient ischemic attack (TIA) has important clinical value. To date, systematic studies on clinical, biochemical, and imaging indicators related to carotid atherosclerosis have been ca...BACKGROUND Early prediction of transient ischemic attack (TIA) has important clinical value. To date, systematic studies on clinical, biochemical, and imaging indicators related to carotid atherosclerosis have been carried out to predict the occurrence of TIA. However, their prediction accuracy is limited. AIM To explore the role of combining wall shear stress (WSS) with conventional predictive indicators in improving the accuracy of TIA prediction. METHODS A total of 250 patients with atherosclerosis who underwent carotid ultrasonography at Naval Military Medical University Affiliated Gongli Hospital were recruited. Plaque location, plaque properties, stenosis rate, peak systolic velocity, and end diastolic velocity were measured and recorded. The WSS distribution map of the proximal and distal ends of the plaque shoulder was drawn using the shear stress quantitative analysis software, and the average values of WSS were recorded. The laboratory indicators of the subjects were recorded. The patients were followed for 4 years. Patients with TIA were included in a TIA group and the remaining patients were included in a control group. The clinical data, laboratory indicators, and ultrasound characteristics of the two groups were analyzed. Survival curves were plotted by the Kaplan-Meier method. Receiver operating characteristic curves were established to evaluate the accuracy of potential indicators in predicting TIA. Logistic regression model was used to establish combined prediction, and the accuracy of combined predictive indicators for TIA was explored.RESULTS The intraclass correlation coefficients of the WSS between the proximal and distal ends of the plaque shoulder were 0.976 and 0.993, respectively, which indicated an excellent agreement. At the end of the follow-up, 30 patients suffered TIA (TIA group) and 204 patients did not (control group). Hypertension (P = 0.037), diabetes (P = 0.026), homocysteine (Hcy)(P = 0.022), fasting blood glucose (P = 0.034), plaque properties (P = 0.000), luminal stenosis rate (P = 0.000), and proximal end WSS (P = 0.000) were independent influencing factors for TIA during follow-up. The accuracy of each indicator for predicting TIA individually was not high (area under the curve [AUC]< 0.9). The accuracy of the combined indicator including WSS (AUC = 0.944) was significantly higher than that of the combined indicator without WSS (AUC = 0.856) in predicting TIA (z = 2.177, P = 0.030). The sensitivity and specificity of the combined indicator including WSS were 86.67% and 92.16%, respectively. CONCLUSION WSS at plaque surface combined with hypertension, diabetes, Hcy, blood glucose, plaque properties, and stenosis rate can significantly improve the accuracy of predicting TIA.展开更多
Patients with mild cognitive impairment after a transient ischemic attack were included in this study. They were treated with Yizhi Xingnao prescription, ergoloid mesylates or aspirin for 60 days. Evaluation using the...Patients with mild cognitive impairment after a transient ischemic attack were included in this study. They were treated with Yizhi Xingnao prescription, ergoloid mesylates or aspirin for 60 days. Evaluation using the Montreal Cognitive Assessment Scale showed that cognitive function was significantly improved in all patients, especially after the combined treatment of Yizhi Xingnao and aspirin. The scores from the Montreal Cognitive Assessment Scale were improved overall and the effective treatment rate was as high as 79%, which was higher than patients treated with a combination of ergoloid mesylates and aspirin, or aspirin alone. Our experimental findings indicate that Yizhi Xingnao prescription can improve mild cognitive impairment after a transient ischemic attack, and that it is more effective than ergoloid mesylates.展开更多
BACKGROUND Thrombocytopenia with thrombosis syndrome has been reported after vaccination against severe acute respiratory syndrome coronavirus 2 with two mRNA vaccines.The syndrome is characterized by thrombosis,espec...BACKGROUND Thrombocytopenia with thrombosis syndrome has been reported after vaccination against severe acute respiratory syndrome coronavirus 2 with two mRNA vaccines.The syndrome is characterized by thrombosis,especially cerebral venous sinus thrombosis,and may lead to stroke.Pregnant women with stroke show higher rates of pregnancy loss and experience serious pregnancy complications.We present the case of a 24-year-old pregnant woman with a transient ischemic attack(TIA) that developed after vaccination with the Moderna mRNA-1273 vaccine(at 37 2/7 wk).CASE SUMMARY TIA occurred 13 d following the coronavirus disease vaccination.At 39 1/7 wk of pregnancy,the patient presented with sudden onset of right eye blurred vision with headache,dizziness with nausea,right-hand weakness,anomia,and alexia.The symptoms lasted 3 h;TIA was diagnosed.Blood test results revealed elevated D-dimer,cholesterol,and triglyceride levels.Brain magnetic resonance imaging showed no acute hemorrhagic or ischemic stroke.At pregnancy 37 6/7 wk,she was admitted for cesarean delivery to reduce subsequent risk of stroke during labor.Body mass index on admission was 19.8 kg/m~2.Magnetic resonance angiography and transesophageal echocardiography showed no abnormalities.The next day,a mature female baby weighing 2895 g and measuring 50 cm was delivered.Apgar scores were 8 and 9 in the first and fifth minutes.D-dimer levels decreased on postoperative day 4.After discharge,the autoimmune panel was within normal limits,including antinuclear and antiphospholipid antibodies.CONCLUSION TIA might be developed after the mRNA vaccines in pregnant women.展开更多
BACKGROUND: If changes of hemodynamics in internal or external cranial artery and stenosis of atherosclerosis are found early, patients with transient ischemic attack (TIA) may be treated at an early phase so as to pr...BACKGROUND: If changes of hemodynamics in internal or external cranial artery and stenosis of atherosclerosis are found early, patients with transient ischemic attack (TIA) may be treated at an early phase so as to prevent and decrease the onset of cerebral infarction. Carotid Doppler can analyze carotid canal wall, hemodynamic properties and stenosis, and changes of plaque morphology; however, transcranial Doppler (TCD) can evaluate vascular stenosis and occlusion and judge collateral circulation in cranium through detecting velocity and direction of blood flow. Can the association of them increase the diagnostic rate of TIA? OBJECTIVE: To evaluate the effect of the association of carotid Doppler and TCD on TIA in internal carotid artery. DESIGN: Contrast observational study. SETTING: Department of Neuroelectrophysiology, Central People’s Hospital of Huizhou. PARTICIPANTS: A total of 54 patients with TIA in internal carotid artery were selected from the Department of Neurology of Huizhou Central People’s Hospital from May 2004 to June 2005. There were 35 males and 24 females aged 46-81 years. The clinical situation was asthenia of single limb, hemiplegia, anaesthesia of single upper or lower limb, hemianesthesia, sensory disorder and aphasia. The symptoms lasted for less than 2 hours. All cases were diagnosed with CT, and those who had pathological changes of acute cerebral infarction and history of cardiac disease were excluded. Additionally, 50 healthy subjects who were regarded as control group were selected from the Department of Neurology of Huizhou Central People’s Hospital. There were 30 males and 20 females aged 45-80 years. All subjects were consent. METHODS: HD15000 color Doppler ultrasound (Philips Company, USA) and Muliti-DopX2 TCD (DWL Company, Germany) were used to detect hemodynamics, stenosis and distribution of atherosclerosis in carotid artery and internal carotid artery. Evaluation of marker: Stenosis was calculated by the ratio between the minimal cavity and vascular sectional area at the maximal site of plaque (mild: stenosis < 50%; moderate and severe: stenosis ≥ 50%). With TCD, the following results were regarded as stenosis: blood velocity of average envelope > 120 cm/s (diagnostic criteria of vascular stenosis of basilar artery: blood velocity of average envelope > 80 cm/s), increase and segmental property of blood flow, and murmu of turbulent flow and vessel. MAIN OUTCOME MEASURES: Positive rate of atherosclerosis and incidence of stenosis with carotid Doppler and TCD. RESULTS: All 54 TIA patients and 50 healthy subjects were involved in the final analysis. ① Results of carotid Doppler: Atherosclerosis and stenosis were obvious in experimental group. Positive rate of atherosclerosis was 85% (46/54) and incidence of stenosis of carotid artery was 41% (22/54), which were higher than those in control group [52% (26/54), 41% (22/54), χ2 = 13.42, 10.90, P < 0.01]. ② Results of TCD: In experimental group, positive rate of atherosclerosis at base of skull was 89% (48/54) and incidence of stenosis of internal cranial artery was 48% (26/54), which were higher than those in control group [62% (31/50), 0, χ2 = 10.28, 32.00, P < 0.01]. Stenosis of artery was mainly involved in middle cerebral artery, initial segment and crotch of carotid artery. CONCLUSION: The association of carotid Doppler and TCD can increase clinically diagnostic rate of TIA and provide bases for apposition and intensity of TIA lesion.展开更多
Recent advances in neuroimaging contribute a lot to the accurate diagnosis and evaluation of cerebrovascular diseases. To explore the relationship among blood perfusion, metabolism and brain structure integrity, 6 Chi...Recent advances in neuroimaging contribute a lot to the accurate diagnosis and evaluation of cerebrovascular diseases. To explore the relationship among blood perfusion, metabolism and brain structure integrity, 6 Chinese transient ischemic attack (TIA) patients with middle cerebral artery (MCA) stenosis were examined by xenon-enhanced computed tomography (Xe-CT), magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) to compare cerebral blood flow (CBF) values, (choline + creatine)/ N-acetyl aspartate [(Cho + Cr)/NAA] values and fractional anisotropy (FA) values in the MCA territory. Our results showed that CBF values significantly decreased in the ipsilateral basal ganglion regions in all 5 cases with unilateral MCA stenosis, with a corresponding decrease of FA values in the same region. In conclusion, decreased blood perfusion may indicate nerve fibre damage in the dominating regions of stenosed arteries.展开更多
Accumulating evidence has demonstrated the involvement of B cells in neuroinflammation and neuroregeneration.However,the role of B cells in ischemic stroke remains unclear.In this study,we identified a novel phenotype...Accumulating evidence has demonstrated the involvement of B cells in neuroinflammation and neuroregeneration.However,the role of B cells in ischemic stroke remains unclear.In this study,we identified a novel phenotype of macrophage-like B cells in brain-infiltrating immune cells expressing a high level of CD45.Macrophage-like B cells chara cterized by co-expression of B-cell and macrophage markers,showed stronger phagocytic and chemotactic functions compared with other B cells and showed upregulated expression of phagocytosis-related genes.Gene Ontology analysis found that the expression of genes associated with phagocytosis,including phagosome-and lysosome-related genes,was upregulated in macrophage-like B cells.The phagocytic activity of macrophage-like B cells was ve rified by immunostaining and three-dimensional reconstruction,in which TREM2-labeled macrophage-like B cells enwrapped and internalized myelin debris after cerebral ischemia.Cell-cell interaction analysis revealed that macrophage-like B cells released multiple chemokines to recruit peripheral immune cells mainly via CCL pathways.Single-cell RNA sequencing showed that the transdiffe rentiation to macrophage-like B cells may be induced by specific upregulation of the transcription factor CEBP fa mily to the myeloid lineage and/or by downregulation of the transcription factor Pax5 to the lymphoid lineage.Furthermore,this distinct B cell phenotype was detected in brain tissues from mice or patients with traumatic brain injury,Alzheimer’s disease,and glioblastoma.Overall,these results provide a new perspective on the phagocytic capability and chemotactic function of B cells in the ischemic brain.These cells may serve as an immunotherapeutic target for regulating the immune response of ischemic stroke.展开更多
Purpose:To analyze the basic situation and health related quality of life(HRQOL)results of patients with transient ischemic attack(TIA),and to study the influencing factors of health related quality of life in patient...Purpose:To analyze the basic situation and health related quality of life(HRQOL)results of patients with transient ischemic attack(TIA),and to study the influencing factors of health related quality of life in patients receiving clopidogrel.Method:Divide the TIA patients into clopidogrel group,aspirin group and untreated group.Measure HRQOL scores of TIA patients using the short form 36 questionnaire(SF-36)scale and analyze influencing factors of HRQOL with one-way ANOVA and multivariate stepwise linear regression statistical methods.Results:The differences of HRQOL scores among three groups are of statistical significance(F=4.29,P=0.00).There is no difference in HRQOL score between clopidogrel group and aspirin group(t=5.35,P=0.00),but HRQOL scores of clopidogrel group and aspirin group are higher than those of the untreated group(t=6.14,P=0.00;t=5.16,P=0.00).The HRQOL scores of clopidogrel group are positively correlated with diet,exercise,gender and family harmony(P<0.05),but negatively correlated with diabetes,hypertension,smoking,drinking,hyperlipidemia,age,career and ABCD2 score(P<0.05).Conclusion:TIA patients who received secondary prevention with clopidogrel and aspirin show better life quality results than those who did not.There were many factors influencing clopidogrel's treatment effect.Paying attention to middle-aged and elderly,the obese,mental workers and female TIA patients,teach TIA patients to quit smoking,drinking and eating low-salt and low-fat food,actively treating their hypertension,hyperlipidemia and diabetes and laying emphasis on psychological counseling and exercise can significantly improve the treatment effect of clopidogrel.展开更多
Transient ischemic attack(TIA) is a warning signal for stroke.A comprehensive evaluation of TIA may reduce the risk for subsequent stroke.Data on the findings of cardiac evaluation with transesophageal echocardiograph...Transient ischemic attack(TIA) is a warning signal for stroke.A comprehensive evaluation of TIA may reduce the risk for subsequent stroke.Data on the findings of cardiac evaluation with transesophageal echocardiography(TEE) in patients with TIA are sparse.Our aims were to determine the frequency of TEE performance and to investigate the findings of TEE in patients with TIA based on the new definition of TIA(i.e.,transient neurological symptoms without evidence of infarction).During a 4-year period(2011–2014),1071 patients(mean age,70 ± 13 years;female,49.7%) with TIA were included in a prospective study and evaluated.Of 1071 consecutive patients suffering from TIA,288 patients(27%) underwent TEE.The median time between admission and TEE was 6 days.Patients with TIA who were evaluated by TEE were younger(67 vs.71 years,P < 0.001) than those who were not evaluated by TEE.They had a higher rate of sensibility disturbance as a TIA symptom(39% vs.31%,P = 0.012) but a lower rate of previous stroke(15% vs.25%,P = 0.001) and atrial fibrillation(2% vs.21%,P < 0.001) than those who did not.Foramen ovale was detected in 71 patients(25.7%),atrial septal aneurysm in 13 patients(4.6%),and severe atherosclerotic plaques(grade 4 and 5) in the aortic arch in 25 patients(8.7%).One patient(0.3%) had a fibroma detected by TEE.In 17 of the 288 patients(6%) who underwent TEE,the indication for anticoagulation therapy was based on the TEE results,and 1 patient with fibroma underwent heart surgery.During hospitalization,7 patients experienced a subsequent stroke,and 27 patients had a recurrent TIA.At 3 months following discharge,the rates of readmission,stroke,recurrent TIA,and death were 19%,2.7%,4.2%,and 1.6%,respectively.The rates of mortality(0.9% vs.1.8%,P = 0.7),stroke risk(1.9% vs.3.0%,P = 0.8),and recurrent TIA(5.0% vs.3.9%,P = 0.8) were similar in patients who underwent TEE and in those who did not.Performing TEE in patients with tissue-based TIA is helpful in detecting cardiac sources for embolism and may indicate for anticoagulation.展开更多
文摘This case report investigates the manifestation of cerebral amyloid angiopathy (CAA) through recurrent Transient Ischemic Attacks (TIAs) in an 82-year-old patient. Despite initial diagnostic complexities, cerebral angiography-MRI revealed features indicative of CAA. Symptomatic treatment resulted in improvement, but the patient later developed a fatal hematoma. The discussion navigates the intricate therapeutic landscape of repetitive TIAs in the elderly with cardiovascular risk factors, emphasizing the pivotal role of cerebral MRI and meticulous bleeding risk management. The conclusion stresses the importance of incorporating SWI sequences, specifically when suspecting a cardioembolic TIA, as a diagnostic measure to explore and exclude CAA in the differential diagnosis. This case report provides valuable insights into these challenges, highlighting the need to consider CAA in relevant cases.
基金a grant from Ever Neuro Pharma GmbH, Austria, Europe
文摘Transient ischemic attack(TIA) is an acute cerebrovascular incident,and is generally considered the best opportunity for early neuroprotective treatment against cerebral ischemia.This study retrospectively analyzed 80 patients with TIA(38 males and 42 females).Among 61 patients who received neuroprotective cerebrolysin treatment within 24 hours after TIA onset,13(21.31%) patients suffered subsequent strokes.Among 19 patients who received neuroprotective cerebrolysin treatment within 24-72 hours after TIA onset,seven(36.84%) developed cerebral infarction.There was a significant difference in the proportion of subsequent strokes between patients receiving cerebrolysin treatment within 24 hours and 24-72 hours after TIA onset(P = 0.438).These findings suggest that neuroprotective drugs administrated within 24 hours after TIA onset help reduce the incidence of subsequent strokes.The results demonstrate usefulness of the ABCD2 score at TIA patients in the determination of short-term and long-term cerebrovascular risk,including the frequency of subsequent ischemic cerebral infarctions up to 12 months.
基金High-educational Talents Starting Foundation of Xinxiang Medical College
文摘BACKGROUND: Recent researches demonstrate that damage of executive function is an early manifestation of vascular cognitive disorder. OBJECTIVE: To investigate the executive functions of patients with transient ischemic attack (TIA). DESIGN: Case control. SETTING: Department of Neurology, the First Affiliated Hospital of Xinxiang Medical College. PARTICIPANTS: A total of 83 TIA patients (46 males and 37 females, aged 32–74 years) were selected from Department of Neurology, the First Affiliated Hospital of Xinxiang Medical College from July 2005 to December 2006. The diagnosis of TIA was established by the criteria of cerebrovascular diseases made by the Fourth National Cerebrovascular Disease Meeting. In these cases, forty-five patients (54%) were involved in internal carotid artery, and thirty-eight patients (46%) were involved in vertebral basilar system. Fifty healthy adults (Control group: 28 males and 22 females, aged 32–74 years) were chosen from retiree in community and family of patients. All of them were right-handedness, without cerebrovascular disease, cerebral trauma, inborn oligophrenia, and hearing and visual disorders; also they had no anxiety and depression nearly one week. In addition, all the subjects cooperated with examination. METHODS: After TIA diagnosis, all patients received neuropsychological examination, including attention and inhibition, working memory, flexibility, planning and diversion, based on Stroop tests (C and CW) and the Wisconsin card sorting tests (WCST). ① WCST test: The edition revised by Nelson was used. We would take the times of sorting, incorrect response, persistent incorrect response, and randomly incorrect response as the index of evaluation. ② Stroop tests: The edition revised by Trenarry was used and this test had two types: form color and form color-word. Their incorrect response and response time were recorded for data analysis in the end. MAIN OUTCOME MEASURES: Results of WCST test and Stroop tests. RESULTS: A total of 83 TIA patients and 50 healthy subjects were involved in the final analysis. Items of Stroop tests, including response time of Stroop-C test, incorrect response of Stroop-C test, response time of Stroop-CW test and incorrect response of Stroop-CW test, and items of WCST, including incorrect response, persistent incorrect response and random incorrect response, between internal carotid artery system and vertebral basilar artery system were (93.87±24.39) s, 3.16±3.97, (228.46±68.13) s, 12.91±10.56, 55.42± 20.38, 26.58±10.41, 28.62±11.22; (96.76±24.75) s, 3.89±4.77, (223.46±72.54) s, 18.71±13.80, 52.47 ±22.25, 28.82±16.20, 23.39±9.72, respectively; this was higher than those in the control group [(52.10± 12.18) s, 1.68±1.97, (134.86±34.15) s, 4.22±4.21, 32.46±17.97, 14.42±8.47, 18.24±10.24, P < 0.05– 0.01]. Times of sorting of WCST between internal carotid artery system and vertebral basilar artery system were obviously lower than those in the control group (8.27±2.73, 8.66±2.77, 11.22±2.41, P < 0.01). However, there were no significant differences between internal carotid artery system and vertebral basilar artery system (P > 0.05). CONCLUSION: Patients with TIA have executive dysfunctions, and the dysfunctions have no difference between internal carotid artery system and vertebral basilar artery system.
基金Supported by Scientific Research Project of Hainan Provincial Health Industry,China,No.20A200081Clinical Medical Center Project of Hainan Province,China,No.QWYH202175.
文摘BACKGROUND Cerebral ischemic stroke is attributed to paradoxical cerebral embolism.Pulmonary arteriovenous fistula(PAVF)is a rare potential cause of cerebral ischemic stroke,and cerebral ischemic stroke induced by PAVF in children is rare.CASE SUMMARY We report a case of right PAVF that presented as a transient ischemic attack(TIA)in a 13-year-old boy.The patient underwent embolization therapy and remained clinically stable for 2 years after treatment.CONCLUSION TIA induced by PAVF in children is rare,lacks typical clinical manifestations,and should not be ignored.
文摘Objective:To compare the diagnostic value of the ABCD2 and ABCD3-栺scoring systems in predicting the development of a 30-day neurological event in adult patients with transient ischemic attack(TIA)presenting to the emergency department.Methods:The study was observational and prospective and was conducted in a single center.The diagnostic values of the ABCD2 and ABCD3-栺scores in predicting a neurological event within one month were compared in patients diagnosed with TIA in the emergency department.Results:A statistically significant difference was observed between groups with or without stroke within one month in terms of both the ABCD2 and ABCD3-栺scores(P=0.044 and P=0.029,respectively).There was no statistically significant difference between the patients with and without a recurrent TIA within one month in relation to the ABCD2 score(P=0.934),but a statistically significant difference was found in the ABCD3-栺scores of these groups(P<0.001).Conclusions:Both the ABCD2 and ABCD3-栺scoring systems could predict ischemic stroke within 30 days of TIA,the ABCD3-栺score is more effective than the ABCD2 score in the prediction of TIA recurrence.
文摘Background Although transient ischemic attacks (TIA) is a clinical diagnosis, imaging findings are important for its diagnosis and treatment. This study evaluated the value and limitations of conventional CT, CT cerebral perfusion imaging and transcranial Doppler sonography (TCD) in patients with TIA. Methods Conventional CT, CT cerebral perfusion imaging and TCD were performed in 20 patients with TIA. After regular CT examination, 40-second dynamic scans were performed on selected slice, while 40 ml of non-ionic contrast materials was bolus-injected through antecubital vein with power injector. These dynamic images were processed with the perfusion software package on workstation. Cerebral blood flow (CBF) and time to peak (TTP) were measured in specific regions of the brain. TCD was also performed in 20 patients with TIA. Comparative analysis was made on the basis of the results of conventional CT, CT cerebral perfusion imaging and TCD. Results In the 20 patients with TIA, conventional CT turned out to be normal. However, persisting abnormal perfusion changes corresponding to clinical symptoms were found in 13 cases with the prolonged TTP. The other 7 cases were normal. TTP of the affected side (11.6±3.0)s was significantly prolonged (t=4.782,P<0.01) in comparison with the contralateral side (8.8±1.5)s. The difference in CBF was not statistically significant (t=1.912, P=0.073) between the affected side [(223.9±19.6) ml·min-1·L-1] and the contralateral side [(227.7±19.8) ml·min-1·L-1] . TCD revealed severe stenosis or occlusion of the carotid artery in 10 patients, arteriosclerosis in 6 patients, blood speed decrease in 2 patients, vasospasm in 1 patient. Conclusions Conventional CT can exclude intracerebral diseases. Perfusion CT provides valuable hemodynamic information and shows the extent of perfusion disturbances. TCD can demonstrate abnormalities of the involved arteries in patients with TIA. The combination of these three imaging methods can provide more diagnostic information.
基金Medical Scientific and Technological Research Foundation of Guangdong Province, No. 2007332 2009360the Natural Science Foundation of Guangdong Province, No. 9451063201002951
文摘BACKGROUND: Due to collateral circulation and cerebrovascular reserve, arterial stenosis and reduced cerebral blood flow may not necessarily indicate impaired cerebral perfusion. Therefore, according to degree of stenosis and clinical symptoms, interventional surgery to relieve arterial stenosis in transient ischemic attack (TIA) patients with major intracranial stenosis is imprudent. Rather, cerebral perfusion and reserve capacity are direct indicators for the assessment of degree and presence of cerebral ischemia. OBJECTIVE: To evaluate cerebral perfusion and reserve in TIA patients with major intracranial stenosis or occlusion using magnetic resonance-perfusion-weighted imaging (MR-PWI) data prior to and following diamox administration. DESIGN, TIME AND SETTING: A self-comparative, neuroimaging observation was performed at the Neurological Department and Radiological Center of the First Affiliated Hospital of Jinan University between December 2007 and April 2009. PARTICIPANTS: Seven acute TIA patients, who were admitted to the Neurological Department of the First Affiliated Hospital of Jinan University between December 2007 and April 2009, were enrolled in the present study. Magnetic resonance imaging confirmed that no acute cerebral infarction happened, nor did bleeding exist. Magnetic resonance angiography, transcranial Doppler ultrasound, and/or digital subtraction angiography confirmed the presence of major intracranial arterial stenosis. Clinical symptoms corresponded to blood supplying regions of the arterial stenosis. METHODS: Baseline MR-PWI was performed on seven patients with intracranial stenosis or occlusion. Two grams of acetazolamide (diamox) were orally administered after 2 days. A second PWI was performed after 2 hours to compare cerebral perfusion parameters prior to and following diamox administration. MAIN OUTCOME MEASURES: PWI results of cerebral perfusion prior to and following diamox administration. RESULTS: The baseline PWI from five patients indicated decreased cerebral perfusion areas. Following oral administration of diamox, cerebral perfusion significantly decreased in those areas. Moreover, new areas of decreased cerebral perfusion were observed in two out of the five patients. In one patient, no significant decrease in cerebral perfusion was found. In another patient, baseline PWI indicated decreased cerebral perfusion in the left hemisphere. However, normal perfusion was observed in both cerebral lobes following diamox administration. CONCLUSION: TIA patients with intracranial stenosis, who are diagnosed by PWI and exhibited decreased cerebral perfusion and reserve, might require further treatment such as intervention by angioplasty.
基金supported by the State"Major New Drug Creation"Major Science and Technology Project of China,No.2009ZX09103-324a grant from the Henan Provincial Science and Technology Innovation Team in University in China,No.2012IRTSTHN011
文摘Flavonoids are a major component in the traditional Chinese medicine Radix Ilicis Pubescentis.Previous studies have shown that the administration of Radix Ilicis Pubescentis total flavonoids is protective in cerebral ischemia.However,to our knowledge,no studies have examined whether the total flavonoids extracted from Radix Ilicis Pubescentis prevent or ameliorate neuronal damage following transient ischemic attacks.Therefore,Radix Ilicis Pubescentis total flavonoids question and the potential underlying mechanisms.Thus,beginning 3 days before the induction of a mouse model of transient ischemic attack using tert-butyl hydroperoxide injections,mice were intragastrically administered 0.3,0.15,or 0.075 g/kg of Radix Ilicis Pubescentis total flavonoids daily for 10 days.The results of spectrophotometric analyses demonstrated that Radix Ilicis Pubescentis total flavonoids enhanced oxygen free radical scavenging and reduced pathological alterations in the brain.Hematoxylin-eosin staining results showed that Radix Ilicis Pubescentis total flavonoids reduced hippocampal neuronal damage and cerebral vascular injury in this mouse model of transient ischemic attack.These results suggest that the antioxidant effects of Radix Ilicis Pubescentis total flavonoids alleviate the damage to brain tissue caused by transient ischemic attack.
基金Supported by Shanghai Health and Family Planning Commission,No.201440051Shanghai Pudong New Area Health and Family Planning Commission,No.PW2016A-19
文摘BACKGROUND Early prediction of transient ischemic attack (TIA) has important clinical value. To date, systematic studies on clinical, biochemical, and imaging indicators related to carotid atherosclerosis have been carried out to predict the occurrence of TIA. However, their prediction accuracy is limited. AIM To explore the role of combining wall shear stress (WSS) with conventional predictive indicators in improving the accuracy of TIA prediction. METHODS A total of 250 patients with atherosclerosis who underwent carotid ultrasonography at Naval Military Medical University Affiliated Gongli Hospital were recruited. Plaque location, plaque properties, stenosis rate, peak systolic velocity, and end diastolic velocity were measured and recorded. The WSS distribution map of the proximal and distal ends of the plaque shoulder was drawn using the shear stress quantitative analysis software, and the average values of WSS were recorded. The laboratory indicators of the subjects were recorded. The patients were followed for 4 years. Patients with TIA were included in a TIA group and the remaining patients were included in a control group. The clinical data, laboratory indicators, and ultrasound characteristics of the two groups were analyzed. Survival curves were plotted by the Kaplan-Meier method. Receiver operating characteristic curves were established to evaluate the accuracy of potential indicators in predicting TIA. Logistic regression model was used to establish combined prediction, and the accuracy of combined predictive indicators for TIA was explored.RESULTS The intraclass correlation coefficients of the WSS between the proximal and distal ends of the plaque shoulder were 0.976 and 0.993, respectively, which indicated an excellent agreement. At the end of the follow-up, 30 patients suffered TIA (TIA group) and 204 patients did not (control group). Hypertension (P = 0.037), diabetes (P = 0.026), homocysteine (Hcy)(P = 0.022), fasting blood glucose (P = 0.034), plaque properties (P = 0.000), luminal stenosis rate (P = 0.000), and proximal end WSS (P = 0.000) were independent influencing factors for TIA during follow-up. The accuracy of each indicator for predicting TIA individually was not high (area under the curve [AUC]< 0.9). The accuracy of the combined indicator including WSS (AUC = 0.944) was significantly higher than that of the combined indicator without WSS (AUC = 0.856) in predicting TIA (z = 2.177, P = 0.030). The sensitivity and specificity of the combined indicator including WSS were 86.67% and 92.16%, respectively. CONCLUSION WSS at plaque surface combined with hypertension, diabetes, Hcy, blood glucose, plaque properties, and stenosis rate can significantly improve the accuracy of predicting TIA.
基金sponsored by Jiangsu Provincial Administration of Traditional Chinese Medicine, No. LB09090
文摘Patients with mild cognitive impairment after a transient ischemic attack were included in this study. They were treated with Yizhi Xingnao prescription, ergoloid mesylates or aspirin for 60 days. Evaluation using the Montreal Cognitive Assessment Scale showed that cognitive function was significantly improved in all patients, especially after the combined treatment of Yizhi Xingnao and aspirin. The scores from the Montreal Cognitive Assessment Scale were improved overall and the effective treatment rate was as high as 79%, which was higher than patients treated with a combination of ergoloid mesylates and aspirin, or aspirin alone. Our experimental findings indicate that Yizhi Xingnao prescription can improve mild cognitive impairment after a transient ischemic attack, and that it is more effective than ergoloid mesylates.
文摘BACKGROUND Thrombocytopenia with thrombosis syndrome has been reported after vaccination against severe acute respiratory syndrome coronavirus 2 with two mRNA vaccines.The syndrome is characterized by thrombosis,especially cerebral venous sinus thrombosis,and may lead to stroke.Pregnant women with stroke show higher rates of pregnancy loss and experience serious pregnancy complications.We present the case of a 24-year-old pregnant woman with a transient ischemic attack(TIA) that developed after vaccination with the Moderna mRNA-1273 vaccine(at 37 2/7 wk).CASE SUMMARY TIA occurred 13 d following the coronavirus disease vaccination.At 39 1/7 wk of pregnancy,the patient presented with sudden onset of right eye blurred vision with headache,dizziness with nausea,right-hand weakness,anomia,and alexia.The symptoms lasted 3 h;TIA was diagnosed.Blood test results revealed elevated D-dimer,cholesterol,and triglyceride levels.Brain magnetic resonance imaging showed no acute hemorrhagic or ischemic stroke.At pregnancy 37 6/7 wk,she was admitted for cesarean delivery to reduce subsequent risk of stroke during labor.Body mass index on admission was 19.8 kg/m~2.Magnetic resonance angiography and transesophageal echocardiography showed no abnormalities.The next day,a mature female baby weighing 2895 g and measuring 50 cm was delivered.Apgar scores were 8 and 9 in the first and fifth minutes.D-dimer levels decreased on postoperative day 4.After discharge,the autoimmune panel was within normal limits,including antinuclear and antiphospholipid antibodies.CONCLUSION TIA might be developed after the mRNA vaccines in pregnant women.
文摘BACKGROUND: If changes of hemodynamics in internal or external cranial artery and stenosis of atherosclerosis are found early, patients with transient ischemic attack (TIA) may be treated at an early phase so as to prevent and decrease the onset of cerebral infarction. Carotid Doppler can analyze carotid canal wall, hemodynamic properties and stenosis, and changes of plaque morphology; however, transcranial Doppler (TCD) can evaluate vascular stenosis and occlusion and judge collateral circulation in cranium through detecting velocity and direction of blood flow. Can the association of them increase the diagnostic rate of TIA? OBJECTIVE: To evaluate the effect of the association of carotid Doppler and TCD on TIA in internal carotid artery. DESIGN: Contrast observational study. SETTING: Department of Neuroelectrophysiology, Central People’s Hospital of Huizhou. PARTICIPANTS: A total of 54 patients with TIA in internal carotid artery were selected from the Department of Neurology of Huizhou Central People’s Hospital from May 2004 to June 2005. There were 35 males and 24 females aged 46-81 years. The clinical situation was asthenia of single limb, hemiplegia, anaesthesia of single upper or lower limb, hemianesthesia, sensory disorder and aphasia. The symptoms lasted for less than 2 hours. All cases were diagnosed with CT, and those who had pathological changes of acute cerebral infarction and history of cardiac disease were excluded. Additionally, 50 healthy subjects who were regarded as control group were selected from the Department of Neurology of Huizhou Central People’s Hospital. There were 30 males and 20 females aged 45-80 years. All subjects were consent. METHODS: HD15000 color Doppler ultrasound (Philips Company, USA) and Muliti-DopX2 TCD (DWL Company, Germany) were used to detect hemodynamics, stenosis and distribution of atherosclerosis in carotid artery and internal carotid artery. Evaluation of marker: Stenosis was calculated by the ratio between the minimal cavity and vascular sectional area at the maximal site of plaque (mild: stenosis < 50%; moderate and severe: stenosis ≥ 50%). With TCD, the following results were regarded as stenosis: blood velocity of average envelope > 120 cm/s (diagnostic criteria of vascular stenosis of basilar artery: blood velocity of average envelope > 80 cm/s), increase and segmental property of blood flow, and murmu of turbulent flow and vessel. MAIN OUTCOME MEASURES: Positive rate of atherosclerosis and incidence of stenosis with carotid Doppler and TCD. RESULTS: All 54 TIA patients and 50 healthy subjects were involved in the final analysis. ① Results of carotid Doppler: Atherosclerosis and stenosis were obvious in experimental group. Positive rate of atherosclerosis was 85% (46/54) and incidence of stenosis of carotid artery was 41% (22/54), which were higher than those in control group [52% (26/54), 41% (22/54), χ2 = 13.42, 10.90, P < 0.01]. ② Results of TCD: In experimental group, positive rate of atherosclerosis at base of skull was 89% (48/54) and incidence of stenosis of internal cranial artery was 48% (26/54), which were higher than those in control group [62% (31/50), 0, χ2 = 10.28, 32.00, P < 0.01]. Stenosis of artery was mainly involved in middle cerebral artery, initial segment and crotch of carotid artery. CONCLUSION: The association of carotid Doppler and TCD can increase clinically diagnostic rate of TIA and provide bases for apposition and intensity of TIA lesion.
文摘Recent advances in neuroimaging contribute a lot to the accurate diagnosis and evaluation of cerebrovascular diseases. To explore the relationship among blood perfusion, metabolism and brain structure integrity, 6 Chinese transient ischemic attack (TIA) patients with middle cerebral artery (MCA) stenosis were examined by xenon-enhanced computed tomography (Xe-CT), magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) to compare cerebral blood flow (CBF) values, (choline + creatine)/ N-acetyl aspartate [(Cho + Cr)/NAA] values and fractional anisotropy (FA) values in the MCA territory. Our results showed that CBF values significantly decreased in the ipsilateral basal ganglion regions in all 5 cases with unilateral MCA stenosis, with a corresponding decrease of FA values in the same region. In conclusion, decreased blood perfusion may indicate nerve fibre damage in the dominating regions of stenosed arteries.
基金National Natural Science Foundation of China,No.82001460the Natural Science Foundation of Zhejiang Province,No.LQ21H250001 (both to LS)。
文摘Accumulating evidence has demonstrated the involvement of B cells in neuroinflammation and neuroregeneration.However,the role of B cells in ischemic stroke remains unclear.In this study,we identified a novel phenotype of macrophage-like B cells in brain-infiltrating immune cells expressing a high level of CD45.Macrophage-like B cells chara cterized by co-expression of B-cell and macrophage markers,showed stronger phagocytic and chemotactic functions compared with other B cells and showed upregulated expression of phagocytosis-related genes.Gene Ontology analysis found that the expression of genes associated with phagocytosis,including phagosome-and lysosome-related genes,was upregulated in macrophage-like B cells.The phagocytic activity of macrophage-like B cells was ve rified by immunostaining and three-dimensional reconstruction,in which TREM2-labeled macrophage-like B cells enwrapped and internalized myelin debris after cerebral ischemia.Cell-cell interaction analysis revealed that macrophage-like B cells released multiple chemokines to recruit peripheral immune cells mainly via CCL pathways.Single-cell RNA sequencing showed that the transdiffe rentiation to macrophage-like B cells may be induced by specific upregulation of the transcription factor CEBP fa mily to the myeloid lineage and/or by downregulation of the transcription factor Pax5 to the lymphoid lineage.Furthermore,this distinct B cell phenotype was detected in brain tissues from mice or patients with traumatic brain injury,Alzheimer’s disease,and glioblastoma.Overall,these results provide a new perspective on the phagocytic capability and chemotactic function of B cells in the ischemic brain.These cells may serve as an immunotherapeutic target for regulating the immune response of ischemic stroke.
文摘Purpose:To analyze the basic situation and health related quality of life(HRQOL)results of patients with transient ischemic attack(TIA),and to study the influencing factors of health related quality of life in patients receiving clopidogrel.Method:Divide the TIA patients into clopidogrel group,aspirin group and untreated group.Measure HRQOL scores of TIA patients using the short form 36 questionnaire(SF-36)scale and analyze influencing factors of HRQOL with one-way ANOVA and multivariate stepwise linear regression statistical methods.Results:The differences of HRQOL scores among three groups are of statistical significance(F=4.29,P=0.00).There is no difference in HRQOL score between clopidogrel group and aspirin group(t=5.35,P=0.00),but HRQOL scores of clopidogrel group and aspirin group are higher than those of the untreated group(t=6.14,P=0.00;t=5.16,P=0.00).The HRQOL scores of clopidogrel group are positively correlated with diet,exercise,gender and family harmony(P<0.05),but negatively correlated with diabetes,hypertension,smoking,drinking,hyperlipidemia,age,career and ABCD2 score(P<0.05).Conclusion:TIA patients who received secondary prevention with clopidogrel and aspirin show better life quality results than those who did not.There were many factors influencing clopidogrel's treatment effect.Paying attention to middle-aged and elderly,the obese,mental workers and female TIA patients,teach TIA patients to quit smoking,drinking and eating low-salt and low-fat food,actively treating their hypertension,hyperlipidemia and diabetes and laying emphasis on psychological counseling and exercise can significantly improve the treatment effect of clopidogrel.
文摘Transient ischemic attack(TIA) is a warning signal for stroke.A comprehensive evaluation of TIA may reduce the risk for subsequent stroke.Data on the findings of cardiac evaluation with transesophageal echocardiography(TEE) in patients with TIA are sparse.Our aims were to determine the frequency of TEE performance and to investigate the findings of TEE in patients with TIA based on the new definition of TIA(i.e.,transient neurological symptoms without evidence of infarction).During a 4-year period(2011–2014),1071 patients(mean age,70 ± 13 years;female,49.7%) with TIA were included in a prospective study and evaluated.Of 1071 consecutive patients suffering from TIA,288 patients(27%) underwent TEE.The median time between admission and TEE was 6 days.Patients with TIA who were evaluated by TEE were younger(67 vs.71 years,P < 0.001) than those who were not evaluated by TEE.They had a higher rate of sensibility disturbance as a TIA symptom(39% vs.31%,P = 0.012) but a lower rate of previous stroke(15% vs.25%,P = 0.001) and atrial fibrillation(2% vs.21%,P < 0.001) than those who did not.Foramen ovale was detected in 71 patients(25.7%),atrial septal aneurysm in 13 patients(4.6%),and severe atherosclerotic plaques(grade 4 and 5) in the aortic arch in 25 patients(8.7%).One patient(0.3%) had a fibroma detected by TEE.In 17 of the 288 patients(6%) who underwent TEE,the indication for anticoagulation therapy was based on the TEE results,and 1 patient with fibroma underwent heart surgery.During hospitalization,7 patients experienced a subsequent stroke,and 27 patients had a recurrent TIA.At 3 months following discharge,the rates of readmission,stroke,recurrent TIA,and death were 19%,2.7%,4.2%,and 1.6%,respectively.The rates of mortality(0.9% vs.1.8%,P = 0.7),stroke risk(1.9% vs.3.0%,P = 0.8),and recurrent TIA(5.0% vs.3.9%,P = 0.8) were similar in patients who underwent TEE and in those who did not.Performing TEE in patients with tissue-based TIA is helpful in detecting cardiac sources for embolism and may indicate for anticoagulation.
