Non-cerebral Infarction Group Research Articles

Prevalence and Radiographic Characteristics of Cerebral Infarction after Surgery in Patients with Glioma: A Retrospective Study.

The aim of our study was to analyze risk factors for postoperative cerebral infarction in patients with glioma in our hospital, and to compare medical imaging techniques for early diagnosis of postoperative cerebral infarction. A retrospective analysis was conducted on 178 patients (male: 78, female: 100) who underwent glioma surgery at our hospital between May 2015 and October 2023. They were divided into two groups based on the presence of postoperative cerebral infarction within 7 days: the cerebral infarction group (n = 85) and the non-cerebral infarction group (n = 93). Magnetic resonance imaging (MRI) was used to assess the location, distribution, and volume of the tumor before surgery. During the perioperative period, patient postoperative time, intraoperative blood loss, and other relevant data were documented. Computed tomography perfusion (CTP) and diffusion-weighted imaging (DWI) imaging techniques were employed to evaluate the occurrence, area, location, and shape of cerebral infarction. The imaging characteristics of postoperative cerebral infarction were noted. Apparent diffusion coefficient values, apparent diffusion coefficient (ADC) of whole-brain CTP parameters, cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), mean transit time (MTT), and DWI parameters were measured. The sensitivity and specificity of CTP, DWI, and their combined diagnosis for postoperative cerebral infarction were compared, with consistency assessed using the Kappa value. This study found that 85 patients (47.8%) experienced postoperative cerebral infarction. Significant risk factors included tumor location in the temporal lobe, tumor volume ≥23.57 cm3, number of surgeries >1, World Health Organization (WHO) grade >3, and intraoperative blood loss >79.83 mL (p < 0.05). Imaging examinations revealed that CTP combined with DWI diagnosis detected cerebral infarctions in 84 patients, showing lower CBF and CBV, and higher TTP, and MTT in the infarct group (p < 0.05). The Kappa values for CTP, DWI, and the combined diagnosis were 0.762, 0.833, and 0.937, respectively (p < 0.001). The prevalence of cerebral infarction in patients with glioma is high and is affected by many factors. Timely imaging examination can detect and predict the occurrence of cerebral infarction in patients after surgery, which is of great significance for improving the prognosis of patients.

Imaging risk factors for postoperative cerebral infarction in adults with ischemic Moyamoya disease

Objective: To investigate the imaging factors associated with postoperative cerebral infarction in adult patients aged 18 and above with ischemic Moyamoya disease. Methods: The clinical data of adult patients who underwent surgeries for ischemic Moyamoya disease in the Department of Neurosurgery at Peking University International Hospital from October 2015 to October 2020 were retrospectively analyzed. Of the 239 patients, 120 were male and 119 were female, with ages ranging from 18 to 63 (41.7±10.3) years. A total of 239 patients(290 cases) underwent direct and indirect combined revascularization (CR).Gender, age, surgical side, preoperative transient ischemic attack (TIA), presence of old cerebral infarction, and imaging features were compared between the patients with (48 cases) and without (242 cases) cerebral infarction within 1 week after surgery. Multivariate logistic binary regression model was used to analyze the imaging risk factors of postoperative cerebral infarction. Results: Cerebral infarction occurred in 48 cases(16.5%) among the 290 CR group within 1 week after surgery. The proportion of patients with TIA, old cerebral infarction, ICA stenosis, A1 segment stenosis, M1 segment stenosis, abnormal posterior cerebral artery (PCA), and unstable compensation before CR in the cerebral infarction group was higher than that in the non-cerebral infarction group (P<0.05).Preoperative TIA (OR=4.514, 95%CI: 1.920-10.611), old cerebral infarction (OR=2.856,95%CI:1.176-6.936), A1 stenosis (OR=7.027,95%CI:1.877-26.308), M1 stenosis (OR=6.968,95%CI:2.162-22.459), abnormal PCA (OR=4.114,95%CI:1.330-12.728)and unstable compensation (OR=4.488,95%CI:1.194-16.865) were risk factors for cerebral infarction after CR surgery (all P<0.05). Conclusion: Among the imaging factors, TIA, old cerebral infarction, A1 stenosis, M1 stenosis, abnormal PCA and unstable compensation were risk factors for cerebral infarction in adult patients with ischemic Moyamoya disease treated by combined revascularization.

Predictive value of whole-brain CT perfusion combined with ABCD3 score for short-term secondary cerebral infarction after TIA.

To investigate the predictive value of Whole Brain CT Perfusion (WB-CTP) combined with the ABCD3 score in patients with transient ischemic attack (TIA). A total of 336 TIA patients with TIA underwent WB-CTP and ABCD3 score assessment within 48 h of admission. Spearman correlation test was performed to analyze the relationship between the degree of vascular stenosis, relative perfusion values, and ABCD3 score. Logistic regression analysis was used to identify independent risk factors for secondary cerebral infarction. Receiver operating characteristic (ROC) curves were generated to evaluate the predictive value of relative cerebral blood flow (rCBF), degree of vascular stenosis, ABCD3 score, and the WB-CTP-ABCD3 combined model for secondary cerebral infarction after TIA. Calibration curves and H-L tests were used to evaluate the predictive efficacy of the model. Among the 336 TIA patients, 143 showed abnormal perfusion areas and 146 had responsible vessel stenosis. The degree of vascular stenosis, relative time-to-maximum (rTmax), and relative mean transit time (rMTT) were positively correlated with the ABCD3 score, while rCBF and relative cerebral blood volume (rCBV) were negatively correlated with the ABCD3 score. ROC curve analysis identified a cutoff value of 0.8205 for rCBF, with a sensitivity of 84.10% and specificity of 58.10% for distinguishing the cerebral infarction group from the non-cerebral infarction group. Furthermore, rCBF ≤ 0.8205, degree of vascular stenosis, and ABCD3 score > 6 were identified as independent risk factors for secondary cerebral infarction in TIA patients within 90 days in TIA patients. The AUC of the WB-CTP-ABCD3 combined model for predicting secondary cerebral infarction within 90 days was 0.836. The model risk was assessed by plotting calibration curves. The value of p for the H-L goodness of fit test was 0.366 (p > 0.05), which indicated that the difference between the obtained model and the perfect model were statistically insignificant. The combined model of WB-CTP-ABCD3 shows promise as a valuable method for predicting secondary cerebral infarction within 90 days following TIA.

Application of neutrophil to lymphocyte ratio to identify CT-negative cerebral infarction with nonfocal symptoms.

BackgroundThe neutrophil to lymphocyte ratio (NLR) has emerged as a strong predictor of mortality in stroke patients. Our study aimed to investigate the correlation between NLR and cerebral infarction with nonfocal symptoms confirmed by diffusion-weighted imaging (DWI) (+).MethodsA total of 439 patients with nonfocal stroke symptoms with CT-negative findings were included from January 1 to December 31, 2018. All patients underwent a head MRI examination within seven days following a head CT examination. The patients’ demographics, medical history, presenting symptoms, and stroke location were recorded. Logistic regression and receiver operating characteristic (ROC) curve analysis were used to identify variables with a significant association with cerebral infarction.ResultsCerebral infarction was detected in 79 (18%) patients confirmed by DWI(+), located mostly in the cerebellum (40.51%). Dizziness (85.19%) was the most common symptom. The cerebral infarction group showed a higher prevalence of hypertension (P<0.0001), diabetes mellitus (P<0.0001), and smoking status (P=0.001) than non-cerebral infarction group. The NLR (P<0.0001) was higher in the cerebral infarction group. There was no significant difference in NIHSS (P=0.09). Logistic analysis revealed that male gender (P=0.046), a history of hypertension (P=0.001), diabetes mellitus (P=0.001), smoking (P=0.023), and NLR (P<0.0001) were the best predictors of cerebral infarction. When integrating sex, hypertension, diabetes mellitus, smoking and NLR, the area under ROC value of the combined method was 0.785, higher than any separate parameters (P<0.05).ConclusionsNLR combined with male gender, a history of hypertension, diabetes mellitus, and smoking, could predict DWI-confirmed cerebral infarction with nonfocal neurologic symptoms with high diagnostic accuracy.

Study on the relationship between post-circulatory lesions and cerebral infarction in children with ischemic moyamoya disease

Objective To explore the relationship between post-circulatory lesions and cerebral infarction in children with ischemic moyamoya disease (MMD). Methods A total of 44 children with ischemic MMD who were admitted to Department of Neurosurgery, Tianjin Medical University General Hospital from January 2010 to December 2018 were retrospectively enrolled into this study. All of them were divided into cerebral infarction group (15 cases) and non-cerebral infarction group (29 cases) according to whether they had cerebral infarction or not. Three cases were treated with encephalo-myosynangiosis (EMS), 5 cases with superficial temporal artery-middle cerebral artery anastomosis bypass (STA-MCA bypass) and 36 cases with EMS+ STA-MCA. All children were followed up by outpatient visits or telephone and were asked about the improvement of clinical symptoms and whether there were any cerebral infarction events. The outcome was assessed by the modified Rankin scale score (mRS). The clinical efficacy was compared between the 2 groups of children. The clinical factors affecting the children with cerebral infarction were further analyzed by single factor and multiple factor logistic regression. Results All 44 patients underwent successful operation. Postoperative complications occurred in 12 cases (27.3%, 12/44). There was no statistically significant difference in the incidence of complications between 2 groups [40.0% (6/15) vs. 28.7% (6/29), P=0.615]. The follow-up duration of 44 cases was 7.2±1.5 months (6-12 months). During the follow-up period, none of the children had cerebral infarction. Among the 44 cases, 35 (79.5%) had good outcomes and 9 (20.5%) had poor outcomes. There was no statistically significant difference in the favorable prognosis rate between the 2 groups [66.7% (10/15) vs. 86.3% (25/29), P=0.130]. Single factor analysis showed that MCA stenosis, PCA (posterior cerebral artery) stenosis and transient ischemic attack before operation were the influencing factors of cerebral infarction in children (all P < 0.05). Further multiple factor analysis showed that PCA stenosis was an independent risk factor for cerebral infarction in children (OR=5.465, 95% CI: 1.224-24.400, P=0.026). Conclusion In children with ischemic MMD, PCA stenosis is an independent risk factors for cerebral infarction, and whether there is cerebral infarction has no significant effect on the prognosis of those children. Key words: Moyamoya disease; Child; Factor analysis, statistical; Post-circulatory lesions; Cerebral infarction

Correlations of acute myocardial infarction complicated by cerebral infarction with insulin resistance, adiponectin and HMGB1.

To investigate the correlations of acute myocardial infarction (AMI) complicated by cerebral infarction with insulin resistance, adiponectin and high-mobility group box 1 (HMGB1). A total of 326 AMI patients receiving percutaneous coronary intervention (PCI) were selected as the research objects. They were divided into cerebral infarction group (n=24) and non-cerebral infarction group (n=302) based on their complication of cerebral infarction. In addition, 165 healthy people were enrolled as control group. Changes in the levels of HMGB1, adiponectin, fasting insulin (FINS), insulin sensitive index (ISI), insulin resistance, N-terminal pro-B-type natriuretic peptide (NT-proBNP), C-reactive protein (CRP), interleukin-6 (IL-6), myocardial infarction markers and coagulation function indexes were compared among the three groups. Correlations among those indexes were analyzed. AMI patients had higher levels of HMGB1, FINS, homeostasis model assessment of insulin resistance (HOMA-IR), ISI, creatine kinase isoenzyme (CK-MB), cardiac troponin I (cTnI), prothrombin time (PT), CRP and IL-6 than those in healthy participates, especially in those complicated with cerebral infarction. Conversely, levels of adiponectin, myoglobin (Mb), activated partial thromboplastin time (APTT), antithrombin III (AT-III), activated coagulation time (ACT) and NT-proBNP were the lowest in cerebral infarction group, and highest in control group (p<0.05). AMI complicated with cerebral infarction was negatively correlated with the levels of AT-III and adiponectin, but positively associated with the levels of NT-proBNP, HOMA-IR and HMGB1 (p<0.05). AMI complicated with cerebral infarction has negative correlations with the levels of AT-III and adiponectin, but positively associated with the levels of NT-proBNP, HOMA-IR and HMGB1, possessing certain clinical significance in AMI treatment.

Study on the correlation between the enhance patterns of carotid plaque and cerebral infarction by contrast-enhance ultrasound

Objective To investigate the characteristics and the enhanced patterns of carotid plaque using contrast-enhanced ultrasound (CEUS) and patients with cerebral infarction. Methods The patients with carotid plaque were divided into two groups according to whether they had cerebral infarction: 54 patients(62 plaques with CEUS) with cerebral infarction were included in group A, and 48 patients (54 plaques with CEUS) without cerebral infarction were included in group B. The plaques were divided into four grades according to the degree of plaque enhancement. According to the source of intraplaque contrast agents, plaque enhancement patterns were divided into adventitia enhancement, lumen enhancement and mixed enhancement. To analyze the degree and pattern of carotid plaque enhancement in the two groups. Results Carotid plaque enhancement in cerebral infarction group was mainly grade 3(26/62) and grade 4(22/62), while that in non-cerebral infarction group was mainly grade 2(20/54) and grade 3(20/54). There was significant difference between the two groups in the proportion of carotid plaque enhancement of grade 2 (P=0.019) and grade 4 (P=0.041). The proportion of plaque adventitia enhancement model in group A(27/59) was lower than that in group B(37/50), with statistically significant difference (P=0.003). While the proportion of mixed enhancement mode in group A was significantly higher than that in group B (P=0.003). Conclusions The enhancement of carotid plaque was obvious in cerebral infarction patients, and the mixed enhancement pattern was more common. It suggested that the communication between vascular cavity and plaque might be an important factor leading to cerebral infarction. Key words: Angiography; Carotid artery diseases; Neovascularization, pathologic; Brain infarction

Acute phase serum cathepsin S level and cathepsin S/cystatin C ratio are the associated factors with cerebral infarction and their diagnostic value for cerebral infarction.

Cathepsin S plays an important role in the pathogenesis of several cardiovascular diseases; however, the relationship between serum cathepsin S and cerebral infarction (CI) is still unknown. This study aimed to investigate the relationship between acute phase serum cathepsin S level and cerebral infarction. A total of 202 stroke patients were enrolled into this study, and were divided into cerebral infarction (n = 140) group and non-cerebral infarction group (non-CI, n = 62). Fifty healthy individuals were recruited as the control group. Serum levels of cathepsin S and cystatin C were measured at days 1, 7, and 14 posthospitalization. Compared to the non-CI group, the CI group had significantly higher rates of hypertension, dyslipidemia, and smoking (all P < 0.05). The CI group had significantly higher cathepsin S levels and cathepsin S to cystatin C ratio (CatS/CysC) at both days 1 and 7 posthospitalization (both P < 0.05). Multivariate logistic regression analysis demonstrated that cathepsin S level (day 7) and CatS/CysC (days 1 and 7) were the associated factors with CI (all P < 0.05). Receiver operating characteristic (ROC) curve analysis revealed that the Area Under Curve (AUC) value of CatS-day7, CatS/CysC-day1, and CatS/CysC-day7 were 0.726 (95% CI: 0.652-0.800, P < 0.001), 0.641 (95% CI: 0.559-0.723, P = 0.001), and 0.721 (95% CI: 0.645-0.797, P = 0.039), respectively. Cathepsin S and CatS/CysC were associated with acute CI, and may have the potential to be the diagnostic biomarkers for CI. Our findings help to better understand the role of serum cathepsin S level in CI.

Clinical and laboratory factors related to acute isolated vertigo or dizziness and cerebral infarction.

ObjectiveTo clarify the relationship of clinical factors with isolated vertigo or dizziness of cerebrovascular origin.MethodsClinical data of patients admitted in East Hospital from Jan. 2015 to Apr. 2016, whose complaint were acute vertigo or dizziness were retrospectively collected. All patients arrived at the emergency department within 24 hr of symptom onset, had no acute ischemic lesion first CT and NIHSS score of 0. Patients were divided into cerebral infarction group and noncerebral infarction group according to subsequent cerebral imaging results and clinical and laboratory factors related to cerebral infarction were analyzed.Result51.6% of patients were female (n = 141). 46 patients (16.8%) were diagnosed with acute cerebral infarction. Baseline demographic data of the two groups was not significantly different. Univariate analysis found that history of smoking (p = 0.009), headache (p = 0.028), unsteadiness (p = 0.009), neuron specific enolase (p = 0.001), and vertebral artery abnormalities found on imaging (p = 0.009) were the significant difference between two groups. Increased neuron specific enolase (p = 0.005) and an abnormal vertebral artery (p = 0.044) were significant on multivariate analysis.Conclusions16.8% of acute isolated vertigo or dizziness presentations were diagnosed with acute cerebral infarction. Increased serum neuron specific enolase and vertebral artery abnormalities were the strongest indicators of acute cerebral infarction.

Factors affecting Blood Pressure Control in Elderly Koreans with Hypertension

Background/Objectives:The prevalence of hypertension increases with advancing age.Uncontrolled hypertension can lead to cerebral- and cardio-vascular diseases. Methods/Statistical analysis: This was a cross-sectional secondary data analysis study that aimed to identify factors influencingblood pressure control in elderly hypertensive patients, using data from the National Health and Nutrition Examination Survey (NHANES).Out of the 7,380 respondents to the third-year (2015) survey of the 6th NHANES, 774 elderly patients who had been diagnosed with hypertension by a physician were enrolled for this study. Findings: In the logistic regression analysis, hypertension control was significantly worse in the group with a spouse compared to the group without a spouse (OD: 0.504, 95% CI: 0.281—0.905), the group with 1 person in the household than the group with 3 or more persons in the household (OD: 0.553, 95% CI: 0.312—0.982), and the “upper-middle class” group than the “upper class” group (OD: 0.449, 95% CI: 0.203—0.984). Multiple logistic regression analysis showed that blood pressure control was significantly better in the cerebral infarction group than in the non-cerebral infarction group (Odds ratio [OR]: 2.360, 95% confidence interval [CI]: 1.290-4.316). Furthermore, blood pressure control was significantly worse in the group of patients with less than 6 hours of sleep (OR: 0.266, 95% CI: 0.114-0.619) and the group of patients with 6–8 hours of sleep (OR: 0.425, 95% CI: 0.199-0.905) than in the group of patients with more than 8 hours of sleep. Improvements/Applications: The findings of this study are meaningful as foundational data to develop interventional programs for aiding in the control of blood pressure among the elderly with hypertension.

Clinical significance and changes of inflammatory cytokines in patients suffered from progressive cerebral infarction

Objective To observe and analyze the changes of inflammatory cytokines levels in patients with progressive cerebral infarction(PCI). Methods The patients with progressive cerebral infarction(progressive cerebral infarction group), the patients with non-progressive cerebral infarction(non progressive cerebral infarction group) and the healthy individuals(control group) were selected as the research subjects.Sixty individuals were included in each group.The levels of IL-8, hs-CRP, SAA of the research subjects were detected and observed. Results The levels of IL-8[(201.89±46.41)mg/L], hs-CRP[(16.55±4.49)mg/L], SAA[(20.65±4.17 )mg/L]of the progressive cerebral infarction group were significantly higher than those of non-progressive cerebral infarction group[(132.02±40.26 )mg/L, (8.09±4.06)mg/L and (15.35±4.07 )mg/L). ]The differences were statistically significant (t=4.289, P=0.000; t=2.276, P=0.006 and t=2.269, P=0.031). Compared with the control group[(50.70±31.14 )mg/L, (0.70±0.11 )mg/L and (5.15±2.21)mg/L], the levels of IL-8, hs-CRP, SAA in the progressive cerebral infarction group and non-progressive cerebral infarction group were significantly higher on the first day ( PCI group vs control: t=3.614, P=0.000; t=3.406, P=0.007; t=2.559, P=0.009; NPCI group vs control: t=3.602, P=0.000; t=3.181, P=0.009; t=1.520, P=0.026). Conclusion The changes of the inflammatory factors levels such as IL-8, hs-CRP, SAA have certain predicative value on the development of the PCI. Key words: Progressive cerebral infarction; Non progressive cerebral infarction; Inflammatory cytokines

Comparison of Long-Term Clinical Outcomes after Drug-Eluting Stent Implantation in Patients with Coronary Artery Disease with and without Prior Cerebral Infarction.

To compare the clinical and angiographic outcomes after implantation of drug-eluting stents (DESs) in patients with coronary artery disease (CAD) with or without prior cerebral infarction. Ninety-eight consecutive patients (130 lesions) who underwent successful coronary DES implantation were prospectively classified into two groups: those with a clinical history of symptomatic cerebral infarction (cerebral infarction group, 49 patients, 69 lesions) and those without a clinical history of symptomatic cerebral infarction (noncerebral infarction group, 49 patients, 61 lesions). The primary endpoint was defined as death, nonfatal myocardial infarction, and cerebrovascular events. The Kaplan-Meier method was used to create a primary endpoint curves to determine the time-dependent cumulative primary endpoint-free rate, which were compared using the log-rank test. The incidence of primary endpoints was higher in the cerebral infarction group than in the noncerebral infarction group (p = 0.0075). The Cox proportional hazards regression model for primary endpoint identified prior cerebral infarction (p = 0.0331, hazard ratio = 2.827) and patients with peripheral artery disease (p = 0.0271, hazard ratio = 2.757) as explanatory factors. The results showed that clinical outcomes were poorer in patients with CAD who had prior cerebral infarctions than in those who did not have infarction.

Does Motor Dysfunction After Cerebral Infarction Impede the Development of Angina Symptoms?

Previous studies based on coronary angiography or computed tomography coronary angiography have demonstrated a high prevalence of coronary stenosis in patients with cerebral infarction and no prior history of coronary artery disease (CAD). The purpose of the present study was to compare the coronary angiographic findings of patients with prior cerebral infarction with those of patients with no prior cerebral infarction. Consecutive patients (n = 126) who underwent a first coronary angiography for suspected CAD but had no prior history of CAD were classified into 2 groups, those with a clinical history of cerebral infarction (cerebral infarction group) and those without a clinical history of cerebral infarction (noncerebral infarction group). The incidences of diabetes mellitus, peripheral artery disease, coronary stenosis, and multivessel disease were significantly higher in the cerebral infarction group than in the noncerebral infarction group. Multiple logistic regression analysis relating to coronary stenosis identifi ed prior cerebral infarction (P = 0.0027, odds ratio = 4.414) and diabetes mellitus (P = 0.0446, odds ratio = 2.619) as explanatory factors. Thirty-four of 78 patients (44%) with coronary stenosis did not have angina symptoms. Multiple logistic regression analysis regarding the lack of angina symptoms identified motor dysfunction (modified Rankin scale ≥ 2) (P = 0.0028, odds ratio = 8.323) as an explanatory factor. The results of the present study suggest that compared with patients without cerebral infarction those with the disorder have a high prevalence of coronary stenosis, and indicate that the development of angina symptoms is influenced by the severity of motor dysfunction.

The expression and clinical significance of MPO in patients with chronic ischemic cerebrovascular disease

Objective To investigate the expression and clinical significance of myeloperoxidase (MPO) in patients with chronic ischemic cerebrovascular disease.Methods 70 carotid atherosclerotic plaques patients with plasma MPO level in our hospital were measured and taken ultrasound examination at the same time.Results There was no significant difference for those with contrast-enhanced imaging and without increase in the general information (P ＞0.05).The enhanced infarct rate was 80.5％ (33/41).The non-enhanced infarct was 44.8％ (13/29).The carotid plaque ultrasound contrast enhancement in patients with cerebral infarction group was significantly higher than non-enhanced group(P ＜ 0.01 ).In the plasma levels of MPO detection,contrast-enhanced carotid ultrasound group was significantly higher than non-enhanced group( P ＜ 0.01 ).The cerebral infarction patients was significantly higher than non-cerebral infarction group (P ＜ 0.01 ).Conclusion The atherosclerotic plaque instability in patients with high expression level of MPO was significantly higher,which indicated high level expression of MPO in the diagnosis of chronic cerebrovascular disease had a very important role.Supplemented by the results of ultrasound imaging may had a clear diagnosis. Key words: Brain ischemia; Peroxidase ; Ultrasonography; Carotid artery diseases