Sequelae Of Cerebral Infarction Research Articles

Analysis of online prescription patterns in Chinese patients with sequelae of cerebral infarction: a real-world study

Cerebral infarction (CI) is a common cerebrovascular disease worldwide, and the burden caused by the sequelae of CI has increased significantly. However, current treatment guidelines lack standardized recommendations for pharmacotherapy of sequelae of CI. This retrospective study collected and analyzed 1.98 million prescriptions concerning sequelae of CI from patients admitted to Zhiyun Health Internet Hospital in 2022. The mean age of patients was 66.2 ± 11.4 years, and 52.40% were male. 79.73% had one or more comorbidities. For treatment, the prescriptions of 1-, 2- and ≥ 3-drug accounted for 64.55%, 23.77% and 11.68% respectively. Chinese patent medicine (CPM) prescriptions, western medicine (WM) prescriptions, and CPM and WM combined (CPM + WM) prescriptions accounted for 53.81%, 27.33%, and 18.86% respectively. In CPM prescriptions, the most frequently prescribed medications were Salvia miltiorrhiza (34.81%), Ginkgo biloba (24.96%), Panax notoginseng (20.67%), Gastrodia (7.15%) and Ligusticum Wallichii (4.90%). For WM prescriptions, the most commonly prescribed agents were anti-hypertensive (32.82%), anti-thrombotic (16.06%), vasodilator (15.70%), anti-dementia (10.88%), and lipid-lowering (9.58%) drugs. Among CPM + WM prescriptions, 72.61% had CPM/WM = 1, 21.20% had CPM/WM < 1, and 6.19% had CPM/WM > 1. This research utilized real-world data extracted from internet hospitals in China to present valuable evidence of online prescription patterns among patients experiencing sequelae of CI.

Consolidation and Reconsolidation of Auditory-Verbal Memory in Parkinson’s Disease

The paper describes the processes of consolidation and reconsolidation of auditory-verbal memory in patients diagnosed with Parkinson’s disease (G20, ICD-10) in comparison with cerebrovascular pathologies of a chronic and acute nature. The research objective was to identify the specifics of consolidation and reconsolidation of auditory-verbal memory in patients of this nosological group. The methods involved an experiment in F. Bartlett’s schema reconstruction, as well as methods of descriptive and comparative statistics. The experiment involved 104 people (67.5 ± 4.5, 21% male), including 30 patients with Parkinson’s disease (G20) (67.8 ± 4.8, 24% male), 34 patients diagnosed with sequelae of cerebral infarction (I69.3) (67.4 ± 4.4, 20% male), and 40 patients with other specified lesions of cerebral vessels on a model of chronic cerebral ischemia (CICI) (I67.8 67.6 ± 4.4, 24% male). All codes were indicated in accordance with ICD-10. The research revealed reliably significant features of consolidation and reconsolidation of auditoryverbal memory in Parkinson’s disease. The greatest number of differences belonged to the comparative analysis with the patients with chronic cerebral ischemia. This nosology was characterized by a greater number of distortion errors but few additions and sequence violations. In Parkinson’s disease, information underwent transformations already at the storing stage, which led to impairment of short-term and long-term memory. Distortion errors were more numerous than consistency errors, which casts doubt on the kinetic factor as the key one.

Zokumeito similar medicine, which is composed of makyokansekito and juzentaihoto, contributed to a rapid recovery of consciousness and physical functions for the sequelae of cerebral infarction: A case report

Zokumeito similar medicine, which is composed of makyokansekito and juzentaihoto, contributed to a rapid recovery of consciousness and physical functions for the sequelae of cerebral infarction: A case report

Research progress on Huangqi Guizhi Wuwu Decoction and predictive analysis of quality markers

Huangqi Guizhi Wuwu Decoction is a classic prescription in traditional Chinese medicine(TCM) and is known for its effects of tonifying Qi, warming the meridians, and promoting blood circulation to alleviate obstruction. It is primarily used to treat conditions characterized by Qi stagnation, Yang deficiency, and obstruction, and it exhibits pharmacological effects such as immune regulation, anti-inflammation, analgesia, protection of the cardiovascular and cerebrovascular systems, itch relief, reduction of frostbite symptoms, antioxidative stress, promotion of cell apoptosis, and kidney protection. In modern clinical practice, it is commonly used to treat acute myocardial infarction, sequelae of cerebral infarction, cervical spondylosis, frozen shoulder, lower limb arteriosclerosis, lower limb vascular disorders, peripheral neuropathy in diabetes, and lupus nephritis. Recent research has focused on the chemical components, pharmacological effects, and clinical applications of Huangqi Guizhi Wuwu Decoction. Based on the &quot;five principles&quot; of quality markers(Q-markers) in TCM, this study predicted and analyzed the Q-markers of Huangqi Guizhi Wuwu Decoction. It suggested that astragaloside Ⅳ, formononetin, kaempferol, quercetin, cinnamic acid, cinnamaldehyde, 6-gingerol, paeoniflorin, albiflorin, and gallic acid could serve as Q-markers for Huangqi Guizhi Wuwu Decoction. The findings of this study can provide references for quality control of Huangqi Guizhi Wuwu Decoction and the development of new Chinese medicinal formulations.

Incidence of Ischemic Stroke in US Veterans Living with Spinal Cord Injury: Preliminary Data (S3.005)

<h3>Objective:</h3> In this preliminary study, we estimate the 4-year incidence of ischemic stroke and associated risk factors in United States (US) Veterans living with spinal cord injuries and disorders (SCI/D). <h3>Background:</h3> People with SCI/D have been reported to have an elevated risk of ischemic stroke, based on a study in the population of Taiwan [Wu et al, Neurology. 2012;78:1051–1057]. This prior study reported a cumulative incidence rate of ischemic stroke of 1.9% over 4 years subsequent to SCI, vs 0.6% in matched non-injured controls. <h3>Design/Methods:</h3> We used Department of Veterans Affairs (VA) administrative databases to examine the incidence of ischemic stroke between fiscal years 2018–2021. Veterans living with strokes were identified using ICD-9 or 10 codes for cerebral infarction or sequelae of cerebral infarction. Veterans with diagnoses of ischemic strokes or sequelae during 2013–2017 were excluded. Statistical analyses included frequencies and multiple regression models. <h3>Results:</h3> From FY 2018–2021, 394 of 12,547 Veterans living with SCI had a newly-recorded ischemic stroke, reflecting a 4-year incidence of 3.14%, and an average annual incidence of 0.79%. Compared to Veterans with a D injury classification by the American Spinal Injury Association (ASIA) Impairment Scale, Veterans with high tetraplegia had a higher likelihood of ischemic stroke (IRR=1.91, 95% CI: 1.37 – 2.67). Compared to Veterans with traumatic SCI, Veterans with non-traumatic SCI/D also had a higher likelihood of ischemic stroke (IRR = 1.43, 95% CI: 1.13 – 1.80). <h3>Conclusions:</h3> US Veterans with SCI/D have a higher incidence of ischemic stroke than that reported for the Taiwanese population with SCI. Tetraplegia and a non-traumatic injury etiology seem to be SCI-centric risk factors. Further study will include comparison of stroke incidence to that of age- and sex-matched US Veterans without SCI. <b>Disclosure:</b> The institution of Dr. Willenberg has received research support from Dept of Veterans Affairs. The institution of Dr. Smith has received research support from Dept of Veterans Affairs . Kevin Stroupe has received research support from Department of Veterans Affairs. Dr. Sippel has nothing to disclose. Zhiping Huo has nothing to disclose. Dr. Sabharwal has received publishing royalties from a publication relating to health care.

Effect of Three Weeks of High-Intensity, Long-Term Preoperative Rehabilitation for Esophageal Cancer Patients with Stroke Sequelae Who Were Considered Unfit for Surgery Due to Low Activity: A Case Report

Treatment of esophageal cancer is based on tumor-node-metastasis (TNM) classification, and surgical treatment is chosen based on the patient's ability to tolerate surgery. Surgical endurance partly depends on activity status, with performance status (PS) generally used as an indicator. This report describes a 72-year-old man with lower esophageal cancer and an 8-year history of severe left hemiplegia. He had sequelae of cerebral infarction and a TNM classification of T3, N1, and M0, and was judged ineligible for surgery because his PS was grade three; he underwent preoperative rehabilitation with hospitalization for 3 weeks. He had been able to walk with a cane in the past, but once he was diagnosed with esophageal cancer, he began using a wheelchair and was dependent on assistance from his family in his daily life. Rehabilitation consisted of strength training, aerobic exercise, gait training, and activities of daily living (ADL) training for 5 h a day, according to the patient's condition. After 3 weeks of rehabilitation, his ADL ability and PS improved sufficiently for surgical indication. No complications occurred postoperatively, and he was discharged when his ADL ability was higher than that before preoperative rehabilitation. This case provides valuable information for the rehabilitation of patients with inactive esophageal cancer.

Analysis of medical service utilization for post-stroke sequelae in Korea between 2016 and 2018: a cross-sectional study

In this retrospective cross-sectional observational study, the medical service utilization of post-stroke sequelae patients was examined using a national patient sample. The Korean Health Insurance Review and Assessment Service-National Patients Sample database was used to investigate the medical service utilization of 19,562 patients, diagnosed with post-stroke sequelae of cerebrovascular disease (I69) in Korea between January 2016 and December 2018. We compared the demographic characteristics, diagnosis code subtypes, frequency of healthcare utilization, medical costs, and comorbidities of standard care (SC) and Korean medicine (KM) users. Overall, patients aged ≥ 65 years accounted for the highest percentage, and utilization of medical services increased among patients aged ≥ 45 years. Outpatient care was higher among SC (79.23%) and KM (99.38%) users. Sequelae of cerebral infarction accounted for the highest percentage of diagnosis subtypes. Physical therapy and rehabilitation therapy were most frequent in SC, whereas injection/procedure and acupuncture were most frequent in KM. Cerebrovascular circulation/dementia drugs were prescribed most frequently in SC. Circulatory, digestive, endocrine, and metabolic disorders were the most common comorbidities in SC, whereas musculoskeletal and connective tissue disorders were most common in KM. Overall, SC and KM users showed differences in the number of medical service claims, cost of care, and comorbidities. Our findings provide basic research data for clinicians, researchers, and policy makers.

Clinical characteristics and risk factors of lower extremity amputation in patients with diabetic foot.

To investigate the risk factors of lower limb amputation, and help physicians better understand the clinical characteristics of patients with diabetic foot, and make treatment strategies for these patients correctly. In this study, the inpatients with diabetic foot treated in our hospital form January 2013 to February 2021 were reviewed retrospectively. The patients were divided into amputation and conservative treatment groups. The variables of the patients, consisting of age, gender, smoking history, alcohol use, diabetes and ulcer duration, ulcer size, Wagner classification, ankle brachial index, previous amputation history, laboratory data, and medical comorbidities including hypertension, coronary artery disease, peripheral arterial disease, chronic renal insufficiency, retinopathy, and sequelae of cerebral infarction were selected for analysis to determine the risk factors of lower limb amputation. In this study, a total of 856 patients with diabetic foot were enrolled, in which 487 patients received amputation surgeries, and the amputation rate was 56.9%. There were significant differences between the two groups in gender (p=0.014), smoking history (p=0.011), ulcer duration (p=0.023), ulcer size (p=0.000), Wagner classification (p=0.000), ABI (p=0.031), peripheral arterial disease (p=0.000), HDL-C (p=0.013), osteomyelitis (p=0.000), and fibrinogen (p=0.001). A stepwise multiple logistic regression analysis revealed that male gender (p=0.003), larger ulcer size (p=0.001), higher Wagner classification grades (p=0.002), higher rate of peripheral arterial disease (p=0.02) and osteomyelitis (p=0.0001), and increased fibrinogen level (p=0.004) were independent risk factors of lower limb amputation in patients with diabetic foot. The diabetic foot patients with male sex, larger ulcer size, higher grade of Wagner classification, peripheral arterial disease or higher fibrinogen level may face higher risk of lower limb amputation.

Abstract 1122‐000140: National Trends in Readmission after Mechanical Thrombectomy in Acute Ischemic Stroke

Introduction : Mechanical thrombectomy (MT) has become the standard of care in patients with large vessel occlusion after trials have demonstrated (MT) improved outcomes in acute ischemic stroke (AIS) as compared to medical therapy. Despite leading to high reperfusion rates, MT patients are at high risk for recurrent ischemic events and complications of stroke. We performed an analysis to evaluate temporal trends in readmission of post‐MT among stroke patients over a three‐year period. Methods : From the Healthcare Cost and Utilization Project Nationwide Readmission Database, we obtained in‐hospital adult patient data with a principal diagnosis of AIS in the US from 2016 to 2018. AIS, MT, thrombolysis treatment and other diagnosis were identified based on International Classification of Diseases, 10th Revision, Clinical Modification codes. We compared the trend of 30‐day readmission in AIS patients who received MT, thrombolysis only and neither treatment with linear regression. Using Clinical Classifications Software Refined tool, we categorized the readmission principal diagnoses of patients underwent MT into groups. All analyses were performed in Stata/SE 15.1 software. Results : Of the 1,271,958 patients admitted from throughout the US with AIS within the study period, 1,130,737 (88.90%) did not receive thrombolysis nor MT, 100,737 (7.92%) received thrombolysis only, and 40,849 (3.21%) underwent MT with or without thrombolysis. The endovascular treatment rate doubled from 2016 (2.40%) to 2018 (4.11%, p &lt; 0.0001). From 2016 to 2018, the readmission rate has significantly decreased from 15.00% to 12.04% (absolute risk reduction (ARR) 2.96%, p = 0.0001) in patients who underwent MT, decreased from 10.46% to 9.51% (ARR 0.95%, p = 0.0097) in patients who received thrombolysis only, and decreased from 11.96% to 11.56% (ARR 0.40%, p = 0.0130) in patients received neither therapy. Among all the patients who underwent MT during the three‐year period, sepsis (1.88%), cerebral infarction (1.59%), sequelae of cerebral infarction (0.82%), cardiac dysrhythmias (0.67%) and heart failure (0.49%) were the most common principal readmission diagnoses. From 2016 to 2018, there were significant decreases in rate of readmissions with septic infection (p = 0.0001), sequelae of cerebral infarction (p &lt; 0.0001), and heart failure (p = 0.0123), but no significant change in cerebral infarction (p = 0.4853) and cardiac dysrhythmias (p = 0.1834). Conclusions : Over three years, the rate of readmissions in AIS patients receiving MT significantly declined, particularly in rate of readmissions in sepsis, sequelae of cerebral infarction, and heart failure. Improved reperfusion rate and better outcomes may explain the reduction in post‐MT complication rate, which needs further studies.

Incidence and Etiologies of Stroke Mimics After Incident Stroke or Transient Ischemic Attack.

Background and Purpose- Stroke mimics (SM) pose a common clinical challenge, but the burden of SM in patients with previous ischemic stroke (IS) or transient ischemic attack is unknown. The objective of this study was to calculate the incidence of SM in IS survivors, compare it with the incidence of recurrent stroke in the same population, and explore the time-dependent patterns of SM etiologies. Methods- This prospective cohort study registered SM events and etiologies among 1872 IS and transient ischemic attack survivors diagnosed with index stroke at Haukeland University Hospital stroke unit from 2007 to 2013 by review of medical records. Cumulative incidences of SM were estimated with a competing risks Cox model and compared with incidence of recurrent stroke in the same population. Results- During 8172 person-years of follow-up, 339 patients had 480 SM events. The cumulative incidence rate of SM during follow-up was 58.7 per 1.000 person-years (95% CI, 53.7-64.2) compared with 34.0 per 1.000 person-years (95% CI, 30.2-38.2) for recurrent stroke in the same time period. The risks of SM and recurrent stroke were highest the first year after index IS or transient ischemic attack. The most frequent SM diagnoses were sequelae of cerebral infarction (19.8%), medical observation, and evaluation for suspected cerebrovascular disease (15.6%) and infections (14.0%). The 2 most frequent and unspecific diagnoses (sequelae of cerebral infarction and medical observation) were clustered in the first months after index stroke. Conclusions- SM after IS or transient ischemic attack are more frequent than recurrent stroke and the risk is especially high in the early period. SMs are multietiological and unspecific diagnoses are most frequent early after index stroke.

Observation of Schlemm\u2019s canal and transluminal trabeculotomy using an ophthalmic endoscope: a case report

BackgroundGonioscopy-assisted transluminal trabeculectomy is a novel and useful technique for ab interno trabeculotomy. However, gonioscopy-assisted transluminal trabeculectomy is difficult to perform in patients with corneal opacity or in patients with sequelae of cerebral infarction and cervical osteoarthritis with severe limitation of spinal mobility. This is because observing Schlemm’s canal during surgery using gonioscopy is difficult. In this report, we introduce a new and beneficial surgical technique of transluminal trabeculotomy for these patients, using an ophthalmic endoscope for cases in which normal gonioscopy-assisted transluminal trabeculectomy is difficult.Case presentationOur patient was a 65-year-old Japanese man with cervical osteoarthritis with severe limitation of spinal mobility who showed primary open-angle glaucoma of the right eye. He had limited conversion of his head during surgery because of complications. Therefore, we performed transluminal trabeculotomy using an ophthalmic endoscope. Finally, ab interno trabeculotomy of 200 degrees was achieved by this method, and an average reduction in ocular pressure of 60% from baseline was achieved after surgery, with no major complications.ConclusionsThis surgical technique may be useful as an alternative method for normal gonioscopy-assisted transluminal trabeculectomy in difficult cases.

Hypoxic preconditioning improves the survival and neural effects of transplanted mesenchymal stem cells via CXCL12/CXCR4 signalling in a rat model of cerebral infarction.

The treatment of neural deficiency after cerebral infarction is challenging, with limited therapeutic options. The transplantation of mesenchymal stem cells (MSCs) to the ischemic penumbra is a potential therapeutic approach. In the present study, a cerebral infarction model was generated by performing middle cerebral artery occlusion (MCAO) in SD rats. The expression of CXCR4 increased, and the number of MSCs migrating to the peri-infarct area was higher in rats transplanted with preconditioned MSCs than in rats transplanted with untreated MSCs. The rate of apoptosis, as evaluated by TUNEL staining and immunoblotting assays, was reduced in rats receiving preconditioned MSCs. A significant amelioration of neural regeneration and improved neurological function were observed in rats injected with preconditioned MSCs compared with those injected with untreated MSCs. However, the application of an siRNA targeting CXCL12 significantly inhibited the protective role of preconditioned MSCs against apoptosis and promoted the migration of MSCs to the ischemic area, leading to impaired neuronal regeneration and limited recovery of neuronal function. Hypoxic preconditioning of MSCs prior to transplantation suppressed apoptosis and increased their migration abilities, leading to the promotion of neuronal regeneration and improvement in neural function after transplantation. This preconditioning strategy may be considered as a potential approach for the modification of MSCs prior to cell transplantation therapy in patients with cerebral infarction. SIGNIFICANCE OF THE STUDY: We found that hypoxic preconditioning of MSCs improved their ability to promote neuronal regeneration and the recovery of neuronal function. Moreover, we showed that CXCR4 inhibited apoptosis, improved cell homing, and promoted neuronal differentiation, without influencing angiogenesis. Our study provides a relatively safe preconditioning method for potential use for cell transplantation therapy in ischemic cerebral infarction. The results presented here will facilitate the development of novel strategies and techniques to improve the tolerance and migration ability of transplanted cells for the treatment of cerebral infarction sequelae.

Placement of a peripherally inserted central catheter in a critically ill patients in intensive care unit: report of one case

Objective To share our experience in the placement of a peripherally inserted central catheter (PICC) in critically ill patients intensive care unit (ICU). Method The clinical data of a critically ill patient placed with PICC from neurosurgery department were collected and analyzed. Result A 78-year-old male patient diagnosed withtype I respiratory failure, aspiration pneumonia, hypertension, and cerebral infarction sequelae successfully received ultrasound-guided modified Seldinger puncture technique for PICC and was treated with intravenous nutrition after repeatedly vascular puncturing failure. Conclusion PICC placement is an effective method for patients in ICU to protect the peripheral vein and lower the incidence of catheter related infections. Key words: Catheterization; Central venous; Intensive care unit; Modified Seldinger technique; Nursing care

Influence factors of dislocation after bipolar prosthetic replacement

To discuss the influence factors of dislocation after bipolar prosthetic replacement. A total of 374 patients who received bipolar prosthetic replacement in our hospital from October 2001 to October 2015 were retrospectively studied. The clinic data of patients with dislocation after operation was summarized to analyze the causes. Dislocation happened in 12 patients among all the 374 patients.10 cases received manual relocation, 2 cases open relocation. Most of the 12 patients were accompanied with neurological and psychiatric disorders, such as Alzheimer's disease, Parkinson's disease, sequelae of cerebral infarction, etc. Some factors like improper body position caused by these complications were the main influence factors of dislocation. Accompanied with neurological and psychiatric disorders is the important influence factor of dislocation after bipolar prosthetic replacement.

The Role of the PI3K Pathway in the Regeneration of the Damaged Brain by Neural Stem Cells after Cerebral Infarction

Neurologic deficits resulting from stroke remain largely intractable, which has prompted thousands of studies aimed at developing methods for treating these neurologic sequelae. Endogenous neurogenesis is also known to occur after brain damage, including that due to cerebral infarction. Focusing on this process may provide a solution for treating neurologic deficits caused by cerebral infarction. The phosphatidylinositol-3-kinase (PI3K) pathway is known to play important roles in cell survival, and many studies have focused on use of the PI3K pathway to treat brain injury after stroke. Furthermore, since the PI3K pathway may also play key roles in the physiology of neural stem cells (NSCs), eliciting the appropriate activation of the PI3K pathway in NSCs may help to improve the sequelae of cerebral infarction. This review describes the PI3K pathway, its roles in the brain and NSCs after cerebral infarction, and the therapeutic possibility of activating the pathway to improve neurologic deficits after cerebral infarction.

Characterization of ultradian and circadian rhythms of core body temperature based on wavelet analysis.

This study was motivated by the needs of precise characterization for the ultradian and circadian rhythmicity of human core body temperature (CBT). The CBT data, two-whole-days' data of two female bed-ridden old aged suffering from cerebral infarction sequelae, was detrended to eliminate the long-term components with periods longer than two days and normalized at first. It was then analyzed by the stationary wavelets transform (SWT) to get the time-frequency information. In the step of SWT, symlet 6 was used, and the approximation waveforms in the 5th, 6th and 7th levels were used to reveal the targeted rhythmicity. The results of the SWT show that SWT can faithfully reveal the time-frequency information of feature elements (peaks and troughs) of waveforms and rhythmicity can be characterized by analyzing temporal information of feature elements.

Colonoscopy-assisted percutaneous endoscopic gastrostomy to avoid a gastrocolocutaneous fistula of the transverse colon

An 80-year-old woman with a nasogastric tube in situ for cerebral infarction sequelae was referred for percutaneous endoscopic gastrostomy (PEG). The abdominal computed tomography scan on admission showed that the transverse colon was interposed between the anterior abdominal wall and the stomach ([Fig. 1]). The usual PEG placement posed a high risk of piercing the transverse colon. A fluoroscopy-assisted colonoscopy was performed, which showed that the transverse colon was present in the upper abdomen ([Fig. 2 a]). While maintaining the tip of the colonoscope at the hepatic flexure, the transverse colon was moved toward the pelvis under fluoroscopic guidance by using a twisting maneuver of the scope shaft. While the colonoscope was in situ, the esophagogastroduodenoscope was inserted ([Fig. 2 b]). The stomach was expanded as usual to perform the PEG. PEG feeding was initiated as usual without problems. When the PEG button was replaced with a new one 6 months later, no specific abnormalities were observed.

Clinical Transplantation of Human Embryonic Neural Stem Cells for the Treatment of Cerebral Infarction Sequelae

Clinical Transplantation of Human Embryonic Neural Stem Cells for the Treatment of Cerebral Infarction Sequelae

Aphasia: early classification, evaluation of existing therapy, and novel therapeutics

Aphasia is a condition which many of us in clinical practice are well acquainted with. It is perhaps most commonly encountered as sequelae of cerebral infarction but also occurs in the context of a range of other neurological disorders such as Alzheimer’s disease and frontotemporal dementia. Its impact on individual patients is frequently profound, commonly underestimated, and often exceeds that of related physical disabilities. As a consequence, an understanding of clinical presentation and management remains an important topic for neurologists. However, to date, there remain few, if any, effective treatments with therapies primarily aimed at allowing patients to adapt and manage their disabilities rather than accomplishing a fundamental change in the natural history of the disorder. The urgency to identify effective treatments is underlined by evidence for an increasing incidence of causative neurodegenerative diseases, which will ensure that the prevalence of aphasia in the population continues to rise. However, the impact of selected pharmacological treatments as well other interventions, including transcranial magnetic stimulation (TMS), are now being more closely evaluated, and if effective, the importance of early identification and classification will become of increasing relevance, and these interventions may also offer the prospect of delaying symptoms in some neurodegenerative disorders. In this month’s Journal club, we review three papers addressing some of these topical issues. The first of these is a prospective case-control study exploring the role of galantamine administration in post-stroke aphasia. The second paper investigates the effectiveness of formal speech and language therapy in the first 4 months after stroke for both aphasia and dysarthria comparing against informal social contact. Finally, the third paper addresses the problems arising from classification of primary progressive aphasia in early and mild disease and in particular early identification in relation to the role of future potential therapeutic interventions.

The biological rhythm in acute cerebral infarction is associated with sleep disorder at the chronic stage

Circadian rhythm with ∼ 24-h periodicity is the most basic and strongest biological rhythm. However, there have been reports of bed-ridden patients with neurodegenerative diseases and unclear circadian rhythm. Sequelae of cerebral infarction include sleep and motor disturbances. Additionally, these are risk factors which induce impairment of quality of life (QOL). We investigated whether biological rhythm disorder in the acute stage of cerebral infarction is associated with sleep disorder in the chronic stage.