Large Area Cerebral Infarction Research Articles

Diagnostic and prognostic implications of non-high-density lipoprotein cholesterol and homocysteine levels for cognitive impairment in thalamic infarction.

Patients with thalamic infarction experience abnormal blockages of multinucleated vessels, affecting the body and thereby the thalamus. Most patients with thalamic infarction have an adverse prognosis, which seriously affects their safety. Therefore, it is essential to analyze the independent risk factors that influence the prognosis of patients with thalamic infarction and develop corresponding preventive measures. To explore the effect of non-high-density lipoprotein cholesterol (non-HDL-C) and Homocysteine (Hcy) levels in cognitive impairment in thalamic infarction. From March 2019 to March 2022, 80 patients with thalamic infarction were divided into a group with cognitive impairment [Montreal Cognitive Assessment (MoCA) score < 26; 35 patients] and a group with normal cognitive function (MoCA score of 26-30; 45 patients) according to the MoCA score. In addition, 50 healthy people in the same period were selected as the control group. A correlation between the non-HDL-C and Hcy levels and the MoCA score and receiver operating characteristic curve was observed, and the serum non-HDL-C and Hcy levels were analyzed for the diagnosis of cognitive impairment in patients with thalamic infarction. According to the Modified Rankin Scale (MRS) score, 80 patients with thalamic infarction were divided into a good prognosis group (MRS score ≤ 2) and a poor prognosis group (MRS score >2). The non-HDL-C and Hcy levels were significantly higher in the group with cognitive impairment than in the group with normal cognitive function (P < 0.05). There was no significant difference in the non-HDL-C level between the control group and the group with normal cognitive function (P > 0.05). The MoCA scores of the group with cognitive impairment were significantly lower than those of the group with normal cognitive function and the control group (P < 0.05). There was a significant difference between the control group and the group with normal cognitive function (P < 0.05). The non-HDL-C and Hcy levels were correlated with the MoCA score (P < 0.05), cognitive impairment [areas under the curve (AUC) = 0.709, 95% confidence interval (95%CI): 0.599-0.816], the non-HDL-C level, and could predict cognitive impairment in patients with thalamic infarction (AUC = 0.738, 95%CI: 0.618-0.859). Hcy combined with non-HDL-C levels can predict cognitive impairment in patients with thalamic infarction (AUC = 0.769, 95%CI: 0.721-0.895).There were 50 patients in the good prognosis group and 30 patients in the poor prognosis group. Compared with the good prognosis group, in the poor prognosis group, the National Institutes of Health Stroke Scale (NIHSS) score, non-HDL-C level, Hcy level, large-area cerebral infarction, atrial fibrillation, and activated partial prothrombin time were statistically significant (P < 0.05). The non-HDL-C level, the Hcy level, the NIHSS score, extensive cerebral serum, and atrial fibrillation may all be independent risk factors for poor prognosis in patients with thalamic infarction (P < 0.05). Non-HDL-C and Hcy levels are positively correlated with cognitive impairment in patients with thalamic infarction. Non-HDL-C and Hcy levels can be used in the diagnosis of cognitive impairment in patients with thalamic infarction, and the combined detection effect is better. The main factors affecting the prognosis of patients with thalamic infarction are the non-HDL-C level, the Hcy level, the NIHSS score, large-area cerebral infarction, and atrial fibrillation. Clinically, corresponding preventive measures can be formulated based on the above factors to prevent poor prognosis and reduce mortality.

Design and Fabrication of Nanofibrous Dura Mater with Antifibrosis and Neuroprotection Effects on SH-SY5Y Cells.

The development and treatment of some diseases, such as large-area cerebral infarction, cerebral hemorrhage, brain tumor, and craniocerebral trauma, which may involve the injury of the dura mater, elicit the need to repair this membrane by dural grafts. However, common dural grafts tend to result in dural adhesions and scar tissue and have no further neuroprotective effects. In order to reduce or avoid the complications of dural repair, we used PLGA, tetramethylpyrazine, and chitosan as raw materials to prepare a nanofibrous dura mater (NDM) with excellent biocompatibility and adequate mechanical characteristics, which can play a neuroprotective role and have an antifibrotic effect. We fabricated PLGA NDM by electrospinning, and then chitosan was grafted on the nanofibrous dura mater by the EDC-NHS cross-linking method to obtain PLGA/CS NDM. Then, we also prepared PLGA/TMP/CS NDM by coaxial electrospinning. Our study shows that the PLGA/TMP/CS NDM can inhibit the excessive proliferation of fibroblasts, as well as provide a sustained protective effect on the SH-SY5Y cells treated with oxygen–glucose deprivation/reperfusion (OGD/R). In conclusion, our study may provide a new alternative to dural grafts in undesirable cases of dural injuries.

Bilateral Longus Colli Abscesses as a Complication of Advanced Bacterial Rhinosinusitis.

Known complications of acute bacterial rhinosinusitis include retropharyngeal abscess, cavernous sinus thrombosis, intracranial abscess, and associated sequelae. We describe the case of a patient with longus colli abscess formation resulting from acute pansinusitis, complicated by bilateral cavernous sinus thrombosis in the setting of concurrent viral pneumonitis, severe sepsis, and a large area cerebral infarction. The bilateral longus colli abscesses were drained via stereotactic image-guided endonasal sinus surgery, yielding Staphylococcus hominis in culture. The described disease progressed rapidly over a 2-week course amid the COVID-19 pandemic.

Rapid calcification after large area cerebral infarction.

Rapid calcification after large area cerebral infarction.

Preliminary study of treatment for chronic symptomatic internal carotid artery long-segmental occlusion

Objective To evaluate the feasibility, safety and efficacy of the treatment of chronic symptomatic internal carotid artery long-segmental occlusion. Methods Fifty-one cases of chronic symptomatic internal carotid artery long-segmental occlusion (arterial occlusion more than 2 anatomical segments) who were treated with hybrid surgery (plaque located at the carotid sinus) or endovascular revascularization (plaque located at the distal end of the internal carotid artery occlusion) from May 2015 to May 2018 were reviewed. Recanalization, perioperative complications, stroke events, and reocclusion events during the follow-up period were recorded. Results The occlusion was recanalized successfully in 45 of 51 patients (88.2%, 45/51), 6 patients failed because the guidewire could not cross the distal arterial occlusion. And the technical success rate was 96.0% (24/25) in hybrid surgery and 80.8% (21/26) in endovascular revascularization. Perioperative complications occurred in 2 patients who underwent combined endovascular treatment. One patient had a small branch embolism due to intraoperative thrombus shift, and 1 patient had large area cerebral infarction. The complications occurred in 2 patients who underwent thybrid surgery, including 1 case of internal carotid cavernous fistula and 1 case of acute reocclusion of internal carotid artery. Forty-four patients with successful operation received clinical follow-up, with the median follow-up time of 24 months (7-43 months). No recurrent stroke and death occurred during the follow-up period. Clinical symptoms were improved in 34 cases. Totally 44 patients received imaging follow-up, and during the median imaging follow-up time of 8 month (4-28 months), 6 cases had reocclusion, and 2 cases had restenosis. Conclusion The treatment of chronic symptomatic internal carotid artery long-segmental occlusion is technically feasible and safety with good short-term efficacy. However, its exact efficacy remains to be confirmed by long-term follow-up studies with large samples. Key words: Carotid artery, internal; Arterial occlusive diseases; Radiology, interventional; Endovascular procedures

Effect of cerebral revascularization combined with craniotomy in the treatment of moyamoya disease complicated with ruptured aneurysm

Objective To investigate the safety and efficacy of cerebral revascularization combined with craniotomy in the treatment of moyamoya disease with ruptured aneurysm. Methods Five patients with moyamoya disease or Moyamoya Syndrome complicated with ruptured aneurysms (5 aneurysms) were treated at Department of Neurosurgery, Henan Provincial People's Hospital from June 2016 to March 2018. All patients underwent extracranial and extracranial revascularization combined with craniotomy for aneurysm clipping. Five patients were followed up after operation. The results of follow-up were as follows: digital subtraction angiography (DSA) or perfusion weighted imaging (PWI) was used to evaluate the long-term cerebral revascularization and the effect of aneurysm. The recovery of neurological function was evaluated by modified Rankin scale (mRS) and activities of daily living scale (ADL). Results The operations of all 5 patients were successful. Intraoperative fluorescence angiography showed that the intracranial aneurysm did not develop and the bridge vessels were anastomosed unobstructed. No new blood foci were found in 5 patients with CT after operation and there were no complications such as infection, new infarction or bleeding. The follow-up time of 5 patients was 6 to 21 months, with an average of 17.6±1.7 months. DSA showed that the aneurysm did not develop and the bridge vessels were unobstructed in 5 patients at 6 months after operation. During the follow-up period, none of the 5 patients had any new neurological deficit symptoms, and there was no hyperperfusion hemorrhage or large-area cerebral infarction. At the last follow-up, the mRS of 5 patients was 0-3, with an average of 1.4±1.0. The ADL of 5 patients was 55-90, with an average of 76±12 at the last follow-up. Conclusion Cerebral revascularization combined with craniotomy seems safe and effective in the treatment of moyamoya disease with ruptured aneurysm. Key words: Moyamoya disease; Aneurysm, ruptured; Microsurgery; Cerebral revascularization; Treatment outcome

Risk factors and prognosis of acute cerebral infarction patients complicated with pulmonary infection

Objective To explore the risk factors and prognosis of pulmonary infection in patients with acute cerebral infarction. Methods From May 2015 to October 2017, the clinical data of 236 patients with acute cerebral infarction in the First People's Hospital of Jinzhong were studied.The patients were divided into infection group (36 cases) and uninfected group (200 cases) according to whether or not the infection occurs.The clinical data and prognosis were compared between the two groups for half a year. Results The age, disturbance of consciousness, difficulty swallowing, invasive operation, large area cerebral infarction between the infected group and uninfected group had statistically significant differences (t=11.093, χ2=83.388, 69.925, 43.274, 151.345, all P<0.05). Logistic regression analysis showed that the results of age, consciousness disorder, dysphagia, invasive operation and massive cerebral infarction all had statistically significant differences(all P<0.05). In the infected group, the length of hospitalization[(23.24±5.61)d] and the cost of hospitalization[(15 239.24±3 522.60) CNY]were significantly higher than those in the uninfected group[(15.65±2.35)d, (9687.24±2215.78) CNY](t=13.671, 12.486, all P<0.05). After treatment for 6 months, the neural function defect scale of the infection group[(24.26±2.12)points] was significantly higher than that of the uninfected group[(16.24±2.23)points], and the daily life activities ability score of the infection group[(70.12±2.81)points] was significantly lower than that of the uninfected group[(79.24±3.25) points], the differences were statistically significant between the two groups(t=20.009, 15.800, all P<0.05). Conclusion There are many risk factors of pulmonary infection in patients with acute cerebral infarction, such as advanced age, invasive operation, disturbance of consciousness, dysphagia, large area cerebral infarction and so on.The prognosis of patients with acute cerebral infarction complicated with pulmonary infection is poor. Key words: Brain infarction; Respiratory tract infections; Risk factors; Activity of daily living; Length of stay; Cost of hospitalization

Analysis of influential factors of postoperative secondary hydrocephalus in patients with severe and most severe craniocerebral injury

Objective To investigate the risk factors for postoperative secondary hydrocephalus in patients with severe and most severe craniocerebral injury. Methods The clinical data of 144 patients with severe and most severe craniocerebral injury admitted to the Department of Neurosurgery, General Hospital of Ningxia Medical University from June 2010 to December 2013 were analyzed retrospectively. Univariate analysis was used to examine the relationship between the patients’ age, gender, pre/postoperative Glasgow Coma Scale(GCS), site of injury, pre/postoperative intraventricular hematocele, pre/postoperative aqueduct of midbrain and ambient cisterna structure, postoperative large area cerebral infarction, postoperative intracranial infection, postoperative intracranial pressure, as well as the postoperative lumbar puncture and the secondary hydrocephalus, and multivariate logistic analysis was further conducted to investigate the influencing factors of hydrocephalus after procedure. Results The patients with low GCS during the perioperative period(before procedure: P=0.041; after procedure: P=0.039), intraventricular hematocele(before procedure: 0.027; after procedure: 0.039), injury site near skull base(P=0.042), structures of ambient cisterna and aqueduct of midbrain not clear(before procedure: P<0.001; after procedure: P<0.001), postoperative massive cerebral infarction(P=0.031), and postoperative intracranial infection(P=0.027)were the risk factors for secondary hydrocephalus after procedure, and postoperative reduction of intracranial pressure(P=0.001)and early lumbar puncture(P<0.001)were its protective factors. Compared with the patients of the non-lumbar puncture group, postoperative early lumbar puncture could reduce the incidences of acute hydrocephalus(P=0.026)and chronic hydrocephalus(P=0.033)of this kind of craniocerebral injury after the procedure, and there was significant difference in the incidence of hydrocephalus between the patients of both groups. Conclusions The patients with severe and most severe craniocerebral injury who have the low GCS during the perioperative period, preoperative and postoperative intraventricular hematocele, injury site near skull base, structures of the ambient cisterna and aqueduct of midbrain unclear, massive cerebral infarction after procedure, and postoperative intracranial infection are prone to hydrocephalus after procedure. While timely and effectively reducing intracranial pressure and releasing the bloody cerebrospinal fluid after procedure may reduce the occurrence of postoperative hydrocephalus. Key words: Craniocerebral trauma; Hydrocephalus; Neurosurgical procedures; Risk factors

A Large Area Cerebral Infarction Secondary to Low-Grade Glioma in a 4-Year-Old Child

Arterial ischemic stroke of pediatric patient is a severe clinical disorder. It is extremely rare that pediatric ischemic stroke, which is firmly related to primary intracranial low-grade glioma, occurs before surgery. Unlike adult patients, ischemic stroke in pediatric patients could be caused by many factors and the diagnosis is not easy. Mechanical compression from the tumor is most likely to be the direct cause of vascular narrowing, which caused stroke in this case. For those patients with obviously increased intracranial pressure, craniotomy for removing tumor and necrotic brain tissues not only reduce the intracranial pressure, but also erase the cause of ischemic stroke. This should be considered as the first option of treatment.

Clinical analysis on curative effect of large decompression craniectomy for 35 cases of large area cerebral infarction

Objective To explore the clinical effect of large decompression craniectomy in treatment for 35 cases of large area cerebral infarction.Methods 35 cases of large area cerebral infarction were given large decompression craniectomy based on no effect from conservative treatment.Results All patients were all operated successfully, and the cases of ADL Ⅰ～Ⅲ were 24(68.6％).Conclusion Large decompression craniectomy can control the increased intracranial pressure effectively,selecting proper cases and operating timely are the important factors of guaranteeing the surgery effect and improving the prognosis. Key words: Large area cerebral infarction; Large decompression craniectomy; Therapy effect

Diagnosis value of spiral CT in ultra-acute large area cerebral infarction

Objective To explore diagnosis value of spiral CT in ultra-acute large area cerebral infarction. Methods 60 patients with clinical history and CT manifestation of ultra-acute large area cerebral infarction underwent conventional CT scans without contrast enhancement within the first 6 hours after onset of neurological symptoms and signs were retrospectively analyzed. Results In CT plain scan,the density of brain parenchymal reduced in 49 cases,regional cerebral tissue swelled in 38 cases,one side of the middle cerebral artery showed high- density sign in 18 cases,normal sign showed in 11 cases;21 cases were diagnosed in hyperacute cerebral infarction by conventional CT(diagnosis rate 35%). Conclusion Spiral CT had high diagnosis value on ultra-acute large area cerebral infarction. Key words: Tomography,X-ray Computed; Brain infarction

Clinical analysis of massive cerebral infarction after severe head injury

Objective Discussion severe head injury after a large area cerebral infarction in the pathogenesis and treatment. Method 26 patients with severe head injury patients with a large area cerebral infarction were retrospectively analyzed. Result Grade according to GOS: 12 examples death, plant existing 6 cases, severe disability 4 cases, middle disability 3 cases, good recovery 1 cases.Conclusions Severe head injury after a large area cerebral infarction patients make early diagnosis 、understanding of pathogenesis and effective treatment improve the prognosis of patients 、improving the quality of life. Key words: Severe head injury; Cerebral infarction

The clinical features and the risk factor profile of ischemic infarction in elderly type2 diabetes

Objective Find out the clinical features and evaluate the risk factor profile of ischemic infarction in elderly type2 diabetes. Methods We have randomly enrolled 118 type2 elderly diabetes patients with ischemic infarction and 130 subjects without infarction. We anamnestically evaluated the features of ischemic infarction records. The correlated indicators we recorded include: age, waist circumference, Body Mass Index ( BMI ), smoking habit, systolic pressure, blood sugar, glycosylated hemoglobin, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol. These indicators were analyzed and compared in the two groups. Results Type2 Diabetes in elderly people was mostly associated with recurrent multifocal lacunar infarction and large area-cerebral infarction. Using conditional logistic regression analysis,we find that the association of age, systolic pressure, low density lipoprotein cholesterol, postprandial glucose with ischemic infarction in diabetes remained statistically significant after adjustment. Conclusion Our study shows old age,hypertention,hyperlipemia, high blood glucose, hyperinsulinemia and smoking are independent risk factors of ischemic infarction in type2 diabetes. Early synthetic prevention and control of these risk factors should be adopted in the elderly with diabetes to decrease the incidence of ischemic infarction and prolong its development. Key words: Type 2 diabetic mellitus; Cerebral infarction; Risk factors; Aged