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Cobb syndrome, or cutaneomeningospinal angiomatosis, is a clinically rare manifestation of angiomatosis or arteriovenous malformations of the skin, spine, spinal cord, and viscera in the same spinal segment. A 48 years old female patient with Cobb syndrome treated ecently is reported as follow. The patient was admitted to hospital due to lower limbs weakness for three days. Left lumbar and abdominal pain occurred before onset without obvious causes, and then lower limbs weakness occurred. In this case, clinical manifestations were acute onset and development rapidly. Imaging showsed myeleterosis from C 1 to T 11, consistent with vertebral segments of hemangiomas in the left parotid gland, the left axillary, the left subclavian, the right femoribus internus, and the right lobe of the liver, etc. Her symptoms and imaging manifestations all meet the diagnostic criteria of Cobb syndrome. Cobb syndrome is easy to be missed diagnosis and misdiagnozed clinically with poor prognosis. This paper discussed and analyzed the rare case in combination with relevant literature, in order to improve clinicians′ understanding of Cobb syndrome, so as to achieve early diagnosis and treatment, thus to reduce permanent neurological complications.
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Stroke canlead to hemiplegia,aphasia,and cognitive impairment,and also complicate with seizure and epilepsy.In recent years,there are more and more studies about post-stroke seizure and post-stroke epilepsy,but the main focus is on risk factors.This article reviews the risk factors,pathogenesis,and treatment of post-stroke seizure and post-stroke epilepsy.
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Objective To investigate the correlations of serum cystatin C level with severity of stroke and short-term outcome in patients with acute ischemic stroke.Methods Patients with first-ever acute ischemic stroke aged ≥50 years who did not receive thrombolysis and took a visit within 3 d after onset were selected prospectively.The serum cystatin C level was detected within 24 h after admission and various clinical data were collected.The National Institutes of Health Stroke Scale (NIHSS) was used to assess the neurological deficits on the day of admission.The NIHSS score ＜8 was defined as mild stroke and ≥8 was defined as moderate to severe stroke.The modified Rankin Scale (mRS) was used to evaluate the short-term outcome at discharge or 14 d after onset,0-2 was defined as good outcome and ＞2 was defined as poor outcome.Results A total of 188 patients were enrolled,including 93 (49.5％) females and 95 (50.5％) males,their mean age was 65.4 ±9.2 years old (range 50-87).There were 120 patients with mild stroke (63.8％),68 with moderate to severe stroke (36.2％);106 patients (56.4％) had good outcome and 82 (43.6％) had poor outcome.Univariate analysis showed that serum cystatin C level in the moderate to severe stroke group was significantly higher than that in the mild stroke group (1.36 ± 0.29 mg/L vs.1.21 ±0.23 mg/L;t =3.902,P ＜ 0.001),the serum cystatin C level in the poor outcome group was significantly higher than that in the good outcome group (1.38 ± 0.25 mg/L vs.1.22 ± 0.25 mg/L;t =4.101,P =0.001).Multivariate logistic regression analysis showed that the serum cystatin C level was an independent risk factor for stroke severity (odds ratio 12.182,95％ confidence interval 11.163-13.202;P ＜ 0.001) and short-term poor outcome (odds ratio 9.025,95 ％ confidence interval 8.202-9.848;P ＜ 0.001).Conclusion The serum cystatin C level is significantly correlated with the severity of stroke and the short-term outcome in patients with acute ischemic stroke.
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Objective To investigate the relationship betw een the serum bilirubin level and the severity of disease and short-term outcome in patient w ith acute ischemic stroke. Methods A total of 120 consecutive inpatients w ith acute ischemic stroke w ere enroled and 105 healthy subjects at the same time w ere used as a control group. The biochemical indicators, such as serum total bilirubin, direct bilirubin, indirect bilirubin, blood lipid, and blood glucose w ere measured w ithin 24 h after admission. The National Institutes of Health Stroke Scale ( NIHSS ) w as used to assess the neurological deficits on the day of admission. The NIHSS score 2 w as defined as poor outcome. The levels of serum total bilirubin, direct bilirubin, and indirect bilirubin w ere measured again. Results The levels of serum total bilirubin, direct bilirubin, and indirect bilirubin in the moderate to severe stroke group w ere significantly higher than those in the mild stroke group ( P 0.05). Conclusions The serum bilirubin level show ed stress increase in patients w ith cerebral infarction in acute phase; and it w as significantly associated w ith the degree of neurological deficit, but it w as not associated w ith short-term outcome. It might be a defense response to the body for stroke events.
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YKL-40 (human cartilage glycoprotein 39) is a newly discovered inflammatory cytokine, which belongs to the member of 18 glycosyl hydrolase of mammal family. Previous studies have indicated that YKL-40 is associated with the acute or chronic inflammatory diseases and tumors. Studies in recent years have suggested that YKL-40 may be involved in the occurrence and development of atherosclerotic plaques, and it is correlated with the plaque instability. The physiological function and the mechanisms of YKL-40 are not fully understood. It may have the roes of promoting vascular smooth muscle migration and proliferation, promoting cell adhesion and proliferation, as well as regulating extracellular matrix remodeling The detection of YKL-40 may have some significance in the aided diagnosis, predicting prognosis, prevention of cardiocerebrovascular diseases, and even the establishment of new therapeutic strategies.
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Control of hypertension is essential for stroke prevention. For most patients, the monotherapy often fails to lower blood pressure to normal levels, while the combination therapy can increase the effect of lowering blood pressure, however, not all the antihypertensive drugs have good efficacy. The early data analysis of the Chinese Hypertension Intervention Efficacy Study and the subgroup analysis of the KYOTO HEART study have showed that dihydropyridine calcium channel blocker amlodipine and angiotensin receptor blocker valsartan are both the most effective antihypertensive drugs in the prevention of stroke.
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Tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) can be induced in ischemia and other pathological states and mediate neuronal apoptosis after cerebral ischemia.Understanding the upregulation mechanism of TRAIL in ischemic brain tissue is promising to develop new treatment for stroke.
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Cerebral artery atherosclerosis is the main reason leading to cerebral infarction. CD40/CD40L overexpression will stimulate the immune and inflammatory responses,leading to local inflammatory cell infiltration within the atherosclerotic plaque, triggering plaque rupture, and thus causing cerebral infarction. Studies have suggested that that CD40L is associated with the severity of cerebral infarction, Therefore, clinical detection of CD40L can be used as an indicator for identifying the severity of cerebral infarction to guide clinical treatment.
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In addition to lipid-lowering,statins also have a wide range of pleiotropy.This article synthesizes and induces the pleiotropy of statins in the prevention and treatment of ischemic cerebrovascular diseases.
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Protein Z (PZ) is a vitamin K-dependent protein. As a cofactor for the protein Z-dependent protease inhibitor (ZPI), it inhibits coagulation factor X under the existence of phospholipid and calcium ion, and increases the ZPI activity by nearly 1000-fold, thus it plays a role in the process of thrombosis. ZPI inhibits coagulation factor Ⅺ a alone. ZPI activity is also consumed in the process of inhabiting factor Ⅹa and Ⅺa. This article reviews the biological characteristics of PZ and ZPI and their association with stroke.
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The human plasma lipoprotein-associated phospholipase A2 (Lp-PLA2) is secreted, by the mature macrophages and lymphocytes, which predominantly binds to low-density lipoprotein. Studies in recent years have demonstrated that Lp-PLA2 plays an important role in the process of atherogenesis. Its gene polymorphisms are associated with the occurrence of ischemic stroke, and its specific inhibitor has anti-atherogenic effects. Lp-PLA2 may be a novel independent risk factor and a therapeutic target for ischemic stroke.
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Neurotrophic factors binds with their specific receptors tropomyosin-related kinase (Trk)to protect ischemic neurons during ischemic brain injury.The studies of the activation mode of Trk expression and its relationship with cerebral ischemia have important value.This article reviews the biological characteristics and action pathway of Trk,its relationship with cerebral ischemia,and its application prospect.
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Angiotensin Ⅱ receptor blockers(ARBs)decrease blood pressure,reverse vascular remodeling,and activate angiotensinⅡsubtype 2(AT2)receptors in order to improve the levels of angiotensinⅡ(AngⅡ),dilate blood vessels,protect against proliferation,and regulate lipid by blocking angiotcnsinⅡtype 1(AT1)receptors.Further understanding the action mech-anism of ARB in neuroprotection may provide a new idea for the treatment of ischemic stroke in clinical practice.
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Statins can substantially lower the incidence of cerebral ischemia and attenuate cerebral ischemic injury. Statins may exert their protective effects via different mechanisms, including stabilizing atherosclerotic plaques, improving endothelial function, reducing inflammatory reaction and reperfusion injury. Moreover, they may also reduce the occurrence of dementia by preventing ?-amyloid from formation and reducing secretion of apolipoprotein E.
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Aquaporin-4 (AQP4) is an important structural basis for water regulation and trans- portation in the central nervous system,which participates in physiopathological processes, such as cerebrospinal fluid reabsorption, osmotic regulation, and cerebral edema formation. Protein kinase C (PKC) exists in various cells, it catalyzes the phosphorylation of serine or threonine residues on various protein substrates.In recent years, studies have found that there is a certain correlation between the expressions of AQP4 and PKC after ischemic stroke.This article re- views the distribution,function,functional regulation of AQP4 and PKC,and their relations in ischemia-reperfusion.
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Objective To investigate the expression of IGF-1 in cerebral tisse,and its correlation with Glutamate expression and neuronal apoptosis,and to study the role of IGF-1 in the pathophysiologie process of ICH.Methods ICH model was induced in rats by infusing 50?l autologous blood into the eaudate nucleus with stereotaetie device.The animals were randomly divided into sham-operation group,ICH group and exogenous IGF-1 intervention group.Every rat was killed and brain tissue was collected.Immunohistoehemitry assay was used to detect the expression of IGF-1 and Glutamate,and TUNEL method used to detect apoptosis in cerebral tissues.Result At 2 hours after ICH,IGF-1 positive cells appeared around the hematoma in the brain,peaked after 24 hours,and returned to normal level on the 7th day. Glutamate positive cells appeared around the hematoma at 2 hours,peaked on the 3rd day,and its high level expression lasted to the 7th day.TUNEL- positive cells appeared at 8 hours,peaked on the 3rd day,and few apoptotic ceils could be found on the 7th day.The expression of IGF-1 was positively correlated with apoptotie cells and the expression of Glutamate.The amounts of Glutamate positive cells and TUNEL positive cells were significantly reduced after intervention with exogenous IGF-1.Conclusion IGF-1 participated in the pathophysiologic course of ICH.IGF-1 repaired and protected the brain tissue from damage after ICH.
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Objective To study the effect of mild hypothermia on neuronal apoptosis and Bcl 2,Bax during cerebral ischemia in middle cerebral artery occlusions(MCAO) in rats.Methods The model of MCAO was set up in rats using the Longa's way,and mild hypothermia was treated for 0.5h,1h,3h. After reperfusion(24h) the rat brains were cut into three sections for TUNEL staining and Bcl 2?Bax protein immunohistochemical staining.Results 1)The numbers of apoptotic cells and Bax cells in the mild hypothermia group(1h, 3h) decreased remarkable as compared with the control group( P
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Objective To study the effect of zVADfmk(a Caspase inhibitor) on Caspase-3 activation and neuronal apoptosis after intracerebral hemorrhage (ICH) in rats.Methods ICH model was made by stereotactic infusing 50?l autologous blood into the caudate nucleus. zVADfmk was given via intraventricular injection. TUNEL staining and immunohistochemitry method were used to detect the expression of apoptosis and Caspase-3 in cerebral tissues at different time point.Results After ICH, Caspase-3 and TUNEL positive cells increased obviously in the perihematomal brain edema zone compared with the pseudo-operation group ( P