Acute Cerebral Stroke Research Articles

Xinnao Shutong Modulates the Neuronal Plasticity Through Regulation of Microglia/Macrophage Polarization Following Chronic Cerebral Hypoperfusion in Rats.

Xinnao shutong (XNST) capsules have been clinically used in China to treat cerebrovascular diseases. Previous studies have demonstrated that XNST has significant neuroprotective effects against acute cerebral ischemic stroke. The present study investigated the effects and mechanisms of XNST treatment following chronic cerebral hypoperfusion. Thirty-six adult male Sprague-Dawley rats were treated with XNST or vehicle following permanent bilateral common carotid artery (BCCA) ligation. Body weight was recorded on days 0, 3, 7, 14, 28, and 42 post-surgery. The Morris water maze (MWM) test was used to assess cognitive function in rats. Immunofluorescent staining and western blot were used to assess the severity of neuronal plasticity, white matter injury, and the numbers and/or phenotypic changes incurred to microglia. Protein levels of p-AKT (Thr308) and p-ERK (Thr202/Tyr204) were detected 42 days after BCCA ligation was performed. The results indicate that XNST treatment significantly reduced escape latency, decreased the frequency of platform crossing compared to the vehicle group. Synaptophysin, protein levels improved and white matter injury ameliorated following XNST treatment. Meanwhile, XNST reduced the number of M1 microglia and increased the number of M2 microglia. Furthermore, p-AKT (Thr308) and p-ERK (Thr202/Tyr204) levels were increased 42 days following BCCA ligation. In summary, our results suggest that XNST mitigates memory impairments by restoration of neuronal plasticity and by modulation of microglial polarization following chronic cerebral hypoperfusion in rats.

Sleep-disordered breathing in patients with acute cerebral stroke

The aim of the study was to investigate prevalence and types of sleep-disordered breathing (SDB) in patients with acute stroke. Methods. We prospectively enrolled 56 patients with acute stroke and 28 age- and gender-matched controls. The assessment included physical examination, brain computer tomography or magnetic resonance imaging or both, and full polysomnography. Stroke severity was assessed by the National Institutes of Health Stroke Scale (NIHSS) and outcomes ere assessed by the modified Rankin scale (mRS). Results. SDB was more prevalent in stroke patients than in control subjects (67.9% vs 10.7%, respectively; p = 0.001). Median apnea-hypopnea index (AHI) was higher in stroke patients compared to the control group (p = 0.001). SDB prevalence did not differ significantly between patients with ischemic or hemorrhagic stroke (p = 0.487). Compared to stroke patients without SDB, stroke patient with SDB were older (p = 0.031), more often were male (p = 0.04), more often had chronic heart failure (p = 0.016) and had higher mRS score 1 year after stroke (p = 0.033). No correlation was found between the prevalence of SDB and lesion location. SDB was predominantly obstructive in 65.8% and predominantly central in 34.2% of patients. Patients with central sleep apnea were older (p = 0.005), had lower BMI (p = 0.014) and more often suffered from atrial fibrillation (p = 0.005) and chronic heart failure (p < 0.001). Conclusion. SDB is highly prevalent in patients with acute stroke. Patients with SDB have worse functional outcome one year after stroke.

2.1-O8Distribution of risk factors for cardiovascular disease and 10-year risk of acute myocardial infarction and cerebral stroke in Sami and non-Sami populations in Norway. The SAMINOR 2 Clinical Survey.

2.1-O8Distribution of risk factors for cardiovascular disease and 10-year risk of acute myocardial infarction and cerebral stroke in Sami and non-Sami populations in Norway. The SAMINOR 2 Clinical Survey.

Pien-Tze-Huang protects cerebral ischemic injury by inhibiting neuronal apoptosis in acute ischemic stroke rats

Ethnopharmacological relevancePien-Tze-Huang (PZH) is a famous formula of traditional Chinese medicine used to treating stroke. However, the protective effect of PZH and its mechanisms in acute ischemic stroke remain to be explored. Aim of the studyTo investigate the protective effect of PZH on neuronal apoptosis in acute cerebral ischemic injury rats and explore its underlying mechanisms. Materials and methodsThe effects of PZH were studied in acute ischemic stroke rats induced by transient middle cerebral artery occlusion, and the mitochondria-mediated apoptotic proteins including cytochrome C (Cyt C), Bax, Bcl-xl, P53, caspase-3, and caspase-9 as well as AKT and glycogen synthase kinase-3 beta (GSK-3β) were assessed. ResultsFour days of PZH treatment (180 mg/kg) could significantly reduce cerebral infarct volume, improve neurological deficit, attenuate inflammatory response, and inhibit neuronal apoptosis in acute ischemic stroke rats. Moreover, PZH treatment significantly decreased cytosolic Cyt C, Bax, P53, cleaved caspase-3, and cleaved caspase-9 levels, but elevated mitochondrial Cyt C and Bcl-xl levels. PZH treatment also increased phosphorylation of AKT and GSK-3β. ConclusionPZH potently protects the brain from cerebral ischemia/reperfusion injury in vivo, and inhibiting mitochondria-mediated neuronal apoptosis as well as attenuating inflammatory responses may be involved in this effect. This study provides experimental basis of PZH in treating acute cerebral ischemic stroke, which would provide some novel insights for its prevention and treatment of ischemic stroke.

Thalamic Diaschisis in Acute Ischemic Stroke: Occurrence, Perfusion Characteristics, and Impact on Outcome.

Ipsilateral thalamic diaschisis (ITD) describes the reduction of thalamic function, metabolism, and perfusion resulting from a distant lesion of the ipsilateral hemisphere. Our aim was to evaluate the perfusion characteristics and clinical impact of ITD in acute middle cerebral artery stroke, which does not directly affect the thalamus. One hundred twenty-four patients with middle cerebral artery infarction were selected from a prospectively acquired cohort of 1644 patients who underwent multiparametric computed tomography (CT), including CT perfusion for suspected stroke. Two blinded readers evaluated the occurrence of ITD, defined as ipsilateral thalamic hypoperfusion present on ≥2 CT perfusion maps. Perfusion alterations were defined according to the Alberta Stroke Program Early CT Score regions. Final infarction volume and subacute complications were assessed on follow-up imaging. Clinical outcome was quantified using the modified Rankin Scale. Multivariable linear and ordinal logistic regression analysis were applied to identify independent associations. ITD was present in 25/124 subjects (20.2%, ITD+). In ITD+ subjects, perfusion of the caudate nucleus, internal capsule, and lentiform nucleus was more frequently affected than in ITD- patients (each with P<0.001). In the ITD+ group, larger cerebral blood flow (P=0.002) and cerebral blood volume (P<0.001) deficit volumes, as well as smaller cerebral blood flow-cerebral blood volume mismatch (P=0.021) were observed. There was no independent association of ITD with final infarction volume or clinical outcome at discharge in treatment subgroups (each with P>0.05). ITD had no influence on the development of subacute stroke complications. ITD in the form of thalamic hypoperfusion is a frequent CT perfusion finding in the acute phase in middle cerebral artery stroke patients with marked involvement of subcortical areas. ITD does not result in thalamic infarction and had no independent impact on patient outcome. Notably, ITD was misclassified as part of the ischemic core by automated software, which might affect patient selection in CT perfusion-based trials.

Effect of thrombolytic therapy with ateplase on inflammatory cytokines and Hcy levels in patients with acute cerebral ischemic stroke

Objective To study the clinical curative effect of thrombolytic therapy with ateplase on acute cerebral ischemic stroke(ACIS) and its effect on serum interleukin-6(IL-6), tumor necrosis factor-α(TNF-α) and homocysteine(Hcy) levels. Methods 84 patients with ACIS were selected as observation subjects, and they were divided into observation group and control group according to the random table method, 42 cases in each group.The control group was given conventional treatment of ACIS, and the observation group was given thrombolytic therapy with ateplase on the basis of conventional treatment.The clinical efficacy of the two groups was compared, the National Institutes of Health Stroke Scale(NIHSS) scores, Barthel index changes before treatment and 24h, 14d after treatment, the IL-6, TNF-α and Hcy levels before treatment and 14d after treatment of the two groups were observed and compared. Results The total effective rate of the observation group was 95.24%, which was significantly higher than 78.57% of the control group(χ2=5.126, P<0.05). The NIHSS scores of the observation group 24h and 14d after treatment were (7.41±1.52)points and (5.48±0.93)points, respectively, which were significantly lower than (9.69±2.08)points and (8.07±1.35)points of the control group(t=5.736, 10.239, all P<0.05). The Barthel index scores of observation group 24h and 14d after treatment were (79.48±5.83)points and (86.21±4.33)points, respectively, which were significantly higher than (54.87±5.51)points and (67.22±4.27)points of the control group(t=19.882, 20.237, all P<0.05).14d after treatment, the levels of IL-6, TNF-α and Hcy in the observation group were (7.61±1.39)ng/L, (5.05±0.66)ng/L, (11.19±2.81)μmol/L, respectively, which were significantly lower than (9.29±1.57)ng/L, (8.79±0.93)ng/L, (15.67±2.32)μmol/L in the control group(t=5.192, 21.254, 7.968, all P<0.05). Conclusion The effect of thrombolytic therapy with ateplase for ACIS patients is significant, which can effectively improve the NIHSS and Barthel index scores, and reduce the serum levels of IL-6, TNF-α and Hcy.It is worthy of clinical promotion. Key words: Alteplase; Stroke; Thrombolytic therapy; Chemokines; Homocysteine

Preliminary study of time maximum intensity projection computed tomography imaging for the detection of early ischemic change in patient with acute ischemic stroke.

Noncontrast computed tomography (NCCT) has been used for the detection of early ischemic change (EIC); however, correct interpretation of NCCT findings requires much clinical experience. This study aimed to assess the accuracy of time maximum intensity projection computed tomography technique (tMIP), which reflects the maximum value for the time phase direction from the dynamic volume data for each projected plane, for detection of EIC, against that of NCCT.Retrospective review of NCCT, cerebral blood volume in CT perfusion (CTP-CBV), and tMIP of 186 lesions from 280 regions evaluated by Alberta Stroke Program Early CT Score (ASPECTS) in 14 patients with acute middle cerebral artery stroke who had undergone whole-brain CTP using 320-row area detector CT was performed. Four radiologists reviewed EIC on NCCT, CTP-CBV, and tMIP in each ASPECTS region at onset using the continuous certainty factor method. Receiver operating characteristic analysis was performed to compare the relative performance for detection of EIC. The correlations were evaluated.tMIP-color showed the best discriminative value for detection of EIC. There were significant differences in the area under the curve for NCCT and tMIP-color, CTP-CBV (P < .05). Scatter plots of ASPECTS showed a positive significant correlation between NCCT, tMIP-gray, tMIP-color, and the follow-up study (NCCT, r = 0.32, P = .0166; tMIP-gray, r = 0.44, P = .0007; tMIP-color, r = 0.34, P = .0104).Because tMIP provides a high contrast parenchymal image with anatomical and vascular information in 1 sequential scan, it showed greater accuracy for detection of EIC and predicted the final infarct extent more accurately than NCCT based on ASPECTS.

Brain computed tomography using iterative reconstruction to diagnose acute middle cerebral artery stroke: usefulness in combination of narrow window setting and thin slice reconstruction.

The purpose of this study is to determine whether iterative model reconstruction (IMR) optimized for brain CT could improve the detection of acute stroke in the setting of thin image slices and narrow window settings. We retrospectively reviewed 27 patients who presented acute middle cerebral artery (MCA) stroke. Images were reconstructed using filtered back projection (FBP; 1- and 5-mm slice thickness) and IMR (1mm thickness), and contrast-to-noise ratios (CNRs) of infarcted and non-infarcted areas were compared. To analyze the performance of acute MCA stroke detection, we used receiver operating characteristic (ROC) curve techniques and compared 5-mm FBP with standard and narrow window settings, and 1-mm FBP and IMR with narrow window settings. The CNR in 1-mm IMR (1.1 ± 1.0) was significantly higher than in 5- (0.8 ± 0.7) and 1-mm FBP (0.4 ± 0.4) (p < 0.001). Furthermore, the average area under the ROC curve was significantly higher with 1-mm IMR with narrow window settings (0.90, 95% CI: 0.86, 0.94) than it was with 5-mm FBP (0.78, 95% CI: 0.72, 0.83). The combination of thin image slices and narrow window settings under IMR reconstruction provide better diagnostic performance for acute MCA stroke than conventional reconstruction methods.

Solumbra thrombectomy as intravascular recanalization for treatment of acute ischemic stroke due to large cerebral artery occlusion

Objective To investigate the feasibility, effectiveness, and technical superiority of Solumbra thrombectomy for treatment of acute large cerebral artery occlusion stroke. Methods 32 patients who had acute large cerebral artery occlusion stroke and received mechanical thrombectomy in TEDA Hospital of Tianjin between January 2013 and August 2016, were divided into two groups: stent group(with conventional stent-retrievers, n=21)and Solumbra group(with Solumbra thrombectomy, n=11). Clinical characteristics, variables correlated with operation, and clinical outcomes were compared and analyzed retrospectively. Results There were no differences in basic clinical and radiographic parameters between stent group versus Solumbra group(all P>0.05). Moreover, there were no differences between Solumbra group versus Stent group in rates of embolus to new territory(18.2% vs.28.6%, P=0.425), in times of thrombectomy(2.2±1.0 vs.2.4±1.3, P=0.657), in non-symptomatic intracranial hemorrhage(18.2% vs.14.3%, P=0.572), in symptomatic intracranial hemorrhage(18.2% vs.9.5%, P=0.427), in TICI 2b/3 revascularization(81.8% vs.81.0%, P=0.670), in puncture-to-reperfusion time[(66.4±39.0)min vs.(51.6±34.5)min, P=0.279], and in NIHSS at 7 days(11.6±7.7 vs.11.3±7.2, P=0.925). A modified Rankin Scale(mRS ≤2)is a variable of recovery of function and good clinical outcome at 90 days.The levels of mRS were similar(P=0.490)between Solumbra and stent groups, but there was a tendency to higher rate of good clinical outcome at 90 days in Solumbra group(63.6%, 7/11)than in stent group(47.6%, 10/21). Conclusions Solumbra thrombectomy as intravascular revascularization technique is an effective and safe strategy for endovascular recanalization of acute large cerebral artery occlusion stroke.Compared with conventional Stent-Retriever thrombectomy, Solumbra thrombectomy has a good clinical outcome tendency at 90 days after operation. Key words: Brain infarction; Solumbra technique

Remote limb ischemic postconditioning promotes motor function recovery in a rat model of ischemic stroke via the up-regulation of endogenous tissue kallikrein.

Remote ischemic conditionings, such as pre- and per-conditioning, are known to provide cardioprotection in animal models of ischemia. However, little is known about the neuroprotection effect of postconditioning after cerebral ischemia. In this study, we aim to evaluate the motor function rescuing effect of remote limb ischemic postconditioning (RIPostC) in a rat model of acute cerebral stroke. Left middle cerebral artery occlusion (MCAO) was performed to generate the rat model of ischemic stroke, followed by daily RIPostC treatment for maximum 21days. The motor function after RIPostC was assessed with foot fault test and balance beam test. Local infarct volume was measured through MRI scanning. Neuronal status was evaluated with Nissl's, HE, and MAP2 immunostaining. Lectin immunostaining was performed to evaluate the microvessel density and area. Daily RIPostC for more than 21days promoted motor function recovery and provided long-lasting neuroprotection after MCAO. Reduced infarct volume, rescued neuronal loss, and enhanced microvessel density and size in the injured areas were observed. In addition, the RIPostC effect was associated with the up-regulation of endogenous tissue kallikrein (TK) level in circulating blood and local ischemic brain regions. A TK receptor antagonist HOE-140 partially reversed RIPostC-induced improvements, indicating the specificity of endogenous TK mediating the neuroprotection effect of RIPostC. Our study demonstrates RIPostC treatment as an effective rehabilitation therapy to provide motor function recovery and alleviate brain impairment in a rat model of acute cerebral ischemia. We also for the first time provide evidence showing that the up-regulation of endogenous TK from remote conditioning regions underlies the observed effects of RIPostC.

Absence of Cortical Vein Opacification Is Associated with Lack of Intra-arterial Therapy Benefit in Stroke.

Purpose To assess the degree of cortical vein opacification in patients with internal carotid artery or middle cerebral artery (MCA) stroke and to evaluate the relationship with treatment benefit from intra-arterial therapy (IAT). Materials and Methods Written informed consent was obtained from all patients in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands. From the trial's database, all patients (recruited from December 2010 until March 2014) with baseline computed tomographic (CT) angiograms were retrospectively included. Enhancement of the vein of Labbé, sphenoparietal sinus, and superficial middle cerebral vein was graded by one neuroradiologist, as follows: 0, not visible; 1, moderate opacification; and 2, full opacification. The sum for the ipsilateral hemisphere was calculated, resulting in the cortical vein opacification score (COVES) (range, 0-6). Primary outcome was the modified Rankin Scale score at 90 days. Association with treatment according to full cortical vein score and different dichotomized cutoff points was estimated with ordinal logistic regression. Interobserver agreement was assessed by two separate observers who reviewed 100 studies each. Results In total, 397 patients were analyzed. Interaction of the cortical vein score with treatment was significant (P = .044) when dichotomized COVES was 0 versus more than 0. The adjusted odds ratio for shift toward better functional outcome was 1.0 (95% confidence interval [CI]: 0.5, 2.0) for a COVES of 0 (n = 123) and 2.2 (95% CI: 1.6, 4.1) for a COVES greater than 0 (n = 274). The multirater κ value was 0.73. Conclusion In this study, patients with acute middle cerebral artery stroke with absence of cortical vein opacification in the affected hemisphere (COVES = 0) appeared to have no benefit from IAT, whereas patients with venous opacification (COVES >0) were shown to benefit from IAT. © RSNA, 2017 Clinical trial registration nos. NTR(1804) and ISRCTN10888758 Online supplemental material is available for this article.

A Prospective Evaluation of Acute Cerebral Ischemic Stroke by Conventional and Diffusion-Weighted MR Imaging Sequences

A Prospective Evaluation of Acute Cerebral Ischemic Stroke by Conventional and Diffusion-Weighted MR Imaging Sequences

Analysis of arterial pressure variability in patients with acute cerebral stroke depending on the time of occurrence.

Analysis of arterial pressure variability in patients with acute cerebral stroke depending on the time of occurrence.

Predictors of in-hospital mortality in acute cerebral stroke in Mansoura University: Five years study

Predictors of in-hospital mortality in acute cerebral stroke in Mansoura University: Five years study

Absence of Cortical Vein Opacification is Associated with Lack of Intra-arterial Therapy Benefit in Stroke.

Patients with acute middle cerebral artery stroke with absence of cortical vein opacification in the affected hemisphere appeared to have no benefit from intra-arterial therapy (IAT), whereas patients with venous opacification were shown to benefit from IAT.

Related Factors of Asymmetrical Vein Sign in Acute Middle Cerebral Artery Stroke and Correlation with Clinical Outcome

The aim of our study was to analyze the related factors of asymmetrical cortical vein sign (ACVS) and asymmetrical medullary vein sign (AMVS) on susceptibility-weighted imaging (SWI) in patients with acute middle cerebral artery (MCA) stroke and whether their presence can be used as an independent predictor for clinical outcome. According to the presence of ACVS and AMVS on SWI, 124 patients with acute MCA stroke within 3 days were divided into several different groups. In addition, those patients were also divided into good and poor outcome group by using the modified Rankin Scale at 3 months after stroke. We investigated respectively the differences in magnetic resonance imaging findings and the clinical data among those different groups. The ACVS was demonstrated in 90 of 124 patients. Of the 90 patients, 47 were accompanied with the AMVS. The rest of 34 patients showed no ACVS and AMVS. The infarct size and MCA status showed significant differences among the ACVS+, AMVS+ group; ACVS+, AMVS- group; and ACVS-, AMVS- group (all P < .001). Moreover, the ACVS, AMVS, and MCA occlusion were more common in the poor outcome group (all P< .001). In the multivariate logistic regression, AMVS (P = .027; odds ratio, 2.37; 95% confidence interval, 1.23-8.73) was associated with poor outcome. The ACVS and AMVS were correlated to the status of MCA steno-occlusion and infarct size, whereas the AMVS was proved to be independently related to the stroke severity and poor outcome rather than the ACVS.

Can clot density predict recanalization in acute ischemic stroke treated with intravenous tPA?

Stroke has become an absolute emergency that is treated by additional endovascular means or by replacing pharmacological options. Modern neuroradiological techniques such as computed tomography (CT) allow us to examine multiple parameters of the diseased brain. These focused on the parenchyma and hemodynamics for pretherapeutic decisions. However, it has become evident that the clot is the current target for interventional measures. Clot length is established as a marker for recanalization. The dense artery sign is known as an acute CT sign of stroke that is readily visible on acute nonenhanced CT. The rationale behind our study was to study if clot density might represent clot vulnerability or resistance to treatment. We conducted a prospective study of all consecutive stroke patients admitted to our hospital over 1 year, who presented with signs of acute middle cerebral artery stroke within the therapeutic window, and who underwent either intravenous or combined intravenous and intra-arterial thrombolysis. All patients were evaluated with a complete stroke CT protocol, transcranial color-coded duplex sonography monitoring, and clinical evaluation with the National Institutes of Health Stroke Scale (NIHSS) score. We measured clot length using planimetry on unenhanced CT and measured Hounsfield units in the clots on the same images. A total of 31 patients were included in the study (19 men, 12 women, aged 35–90 years). We found that patients with a longer clot on the unenhanced CT had a higher NIHSS score, confirming previous literature. However, we found that patients with a lower clot density recanalized to a more marked degree and had a better clinical outcome. Patients who did not recanalize had a higher clot density (49 Hounsfield units) than those who did recanalize (23 Hounsfield units). Overall, measuring the clot seems to be an important additional parameter to be taken into account. In our study, CT clot density seems to correlate with clinical outcome and recanalization. The higher density seems to represent a higher red blood cell content. This is evidence that clot composition could play a much more important role in acute stroke than thought until now and characterizing it with imaging may help in choosing the adequate treatment modality. Higher density seems to reflect erythrocyte content. Therefore, patients with a longer and denser clot may necessitate direct thrombectomy.

A 2-oxa-spiro[5.4]decane scaffold displays neurotrophic, neurogenic and anti-neuroinflammatory activities with high potential for development as a versatile CNS therapeutic

Following our recent discovery of a new scaffold exhibiting significant neurotrophic and neurogenic activities, a structurally tweaked analogue, embodying a 2-oxa-spiro [5.4]decane framework, has been conceptualised and found to be more potent and versatile. It exhibits enhanced neurotrophic and neurogenic action in in vitro, ex vivo and in vivo models and also shows robust neuroprotection in mouse acute cerebral stroke model. The observed attributes are traceable to the predominant activation of the TrkB-PI3K-AKT-CREB pathway. In addition, it also exhibits remarkable anti-neuroinflammatory activity by concurrently down-regulating pro-inflammatory cytokines IL-1α and IL-6, thereby providing a unique molecule with a trinity of neuroactivities, i.e. neurotrophic, neurogenic and anti-inflammatory. The new chemical entity disclosed here has the potential to be advanced as a versatile therapeutic molecule to treat stroke, depression, and possibly other neuropsychiatric disorders associated with attenuated neurotrophic/ neurogenic activity, together with heightened neuroinflammation.

NORRISK 2: A Norwegian risk model for acute cerebral stroke and myocardial infarction.

Background Guidelines for the prevention of cardiovascular disease recommend the estimation of an individual's total risk. We have developed a new model for the prediction of the 10-year risk of incident acute myocardial infarction or cerebral stroke based on Norwegian data, NORRISK 2. Design The model was based on 10-year follow-up of a large population-based cohort (CONOR) through linkage to the CVDNOR project, a database of cardiovascular disease hospital discharge diagnoses and mortality in Norway in 1994-2009. Methods We used the Fine and Gray regression model to estimate the 10-year risk adjusting for competing risk. The model population consisted of participants in 1994-1999 and the external validation population of participants in 2000-2003. We validated the model by area under the receiver operating characteristic curves, calibration plots and analyses of sensitivity and specificity. Results The model population consisted of 31,445 men and 35,267 women aged 40-79 years with 3658 endpoints in men and 2459 in women. The external validation population consisted of 19,980 men and 19,309 women, of whom 1858 men and 874 women had an endpoint during follow-up. The area under the curve was 0.79 (0.79-0.80) in men and 0.84 (0.83-0.85) in women in the model population and was slightly lower in the external validation population. Calibration plots showed good agreement between observed and predicted risk. The sum of sensitivity and specificity was greatest around the suggested risk thresholds. Conclusion The NORRISK 2 model showed good validity in an external dataset and will be a valuable tool to guide decisions about preventive interventions in people without known previous cardiovascular disease.

羚角钩藤汤加减治疗急性脑卒中中枢热36例

目的：观察羚角钩藤汤加减治疗36例中枢热患者的临床疗效。方法：将我院重症监护病房2014年4月~2016年10月间收住的60例急性脑卒中并发中枢热患者，随机分为常规组(对照组) 24例和治疗组36例，所有两组病人均在重症监护下治疗，运用冰帽物理降温，溴隐亭日3次鼻饲，醒脑静静滴，控制血压，预防并发症。治疗组在常规治疗的同时给予羚角钩藤汤鼻饲，治疗7天为一疗程。分别观察两组在治疗3，5，7天的体温控制情况，3，7天意识状态改善情况，及7天后并发症发生的多少，病情预后改善情况。结果：羚角钩藤汤治疗组不仅能有效缩短体温控制的时间，并且对改善患者意识的状态，改善患者的预后，减少并发症等方面均优于对照组。结论：羚角钩藤汤治疗中枢热可明显的缩短控制患者体温的时间，改善意识状态，减少并发症，改善预后，值得推广。 Objective: To observe the clinical efficacy in 36 cases of patients with central heating treated with Ling Jiao Gou Teng Decoction. Method: 60 cases of acute cerebral stroke complicated with central fever patients in ICU of our hospital during on April 2014 to October 2016, were randomly divided into24 cases of routine group (control group) and 36 cases of treatment group. All the two group patients were treated with intensive caring, ice physical cooling, bromocriptine nasal feeding 3 times a day quietly and intravenous infusion of Xingnaojing to control blood pressure and prevent complications at the same time. While in the conventional treatment, the treatment group was also treated 7 days as a course of treatment with nasal feeding with Ling Jiao Gou Teng Decoction. The two groups were observed the results of temperature control in the treatment of 3, 5, 7 days, the state of consciousness improvement on the 3, 7 days, the incidence of complications 7 days later. And the improvement of prognosis was also observed all time. Result: The treatment group treated with Ling Jiao Gou Teng Decoction can not only shorten the time of the temperature control effectively, but also improve the patient’s state of consciousness and prognosis, and polish up complications reduction compared with the control group. Conclusion: Ling Jiao Gou Teng Decoction is of much clinical value because of reducing the time of the patient’s body temperature control, improving the state of consciousness and prognosis and reducing the complications of stroke in central heating.