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Objective:To analyze the prehospital predictors of large-vessel occlusion (LVO) in acute ischemic stroke.Methods:This study recruited patients who had developed LVO for less than 24 hours and had a National Institute of Health Stroke Scale (NIHSS) score ≥ 8 and who received treatment in Lu'an People's Hospital from December 2018 to November 2020. The included patients were divided into LVO and LVO-free groups according to the presence of a large-vessel occlusion determined by magnetic resonance angiography, CT angiography, and digital subtraction angiography. Baseline data (sex, age, disease history, life history, and medication history), NIHSS subscale score, and blood pressure at admission were compared between LVO and LVO-free groups. The efficacy of the factors that were screened for predicting LVO in acute ischemic stroke were compared with the that of commonly used scales.Results:A total of 761 patients with acute ischemic stroke who had an NIHSS score ≥ 8 were included in the final analysis. Among them, 228 patients had an LVO and 533 patients had no LVO. There were significant differences in the proportions of patients with atrial fibrillation ( OR = 5.230, 95% CI = 3.400-8.043, P < 0.001) and systolic blood pressure ≤ 170 mmHg ( OR = 5.181, 95% CI = 3.327-8.068, P < 0.001) between the two groups. Conclusion:Atrial fibrillation and systolic blood pressure ≤ 170 mmHg are greatly associated with the presence of large-vessel occlusion in acute ischemic stroke.
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Objective:To investigate the predictive value of the PREMISE score for early death in Chinese patients with acute ischemic stroke (AIS).Methods:Patients with AIS admitted to the Department of Neurology, Lu'an people's Hospital from January 2019 to December 2019 were enrolled retrospectively. The demographic data and all baseline clinical data were collected, and compared between the early death group and survival group. Early death was defined as death within 7 days after admission. Multivariate logistic regression analysis was used to determine the independent influencing factors for early death in patients with AIS. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of PREMISE score for early death in patients with AIS. Results:A total of 919 patients with AIS were enrolled, 50 of them (5.4%) died early. Multivariate logistic regression analysis showed that fasting blood sugar (odds ratio [ OR] 1.157, 95% confidence interval [ CI] 1.004-1.334; P=0.044), higher National Institutes of Health Stroke Scale score ( OR 1.134, 95% CI 1.051-1.223; P=0.021) and the PREMISE score ( OR 4.047, 95% CI 1.276-12.836; P=0.018) were the independent risk factors for early death in patients with AIS. ROC curve analysis showed that the area under the curve of the PREMISE score predicting early death in patients with AIS was 0.899 (95% CI 0.866-0.931; P<0.001). When the cutoff value of the PREMISE score was 7, the sensitivity and specificity were 88.0% and 79.2%, respectively, the positive predictive value was 19.6%, and the negative predictive value was 99.1%. Conclusions:The PREMISE score has a good predictive value for early death in Chinese patients with AIS.
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Cerebral small vessel disease (CVSD) is a group of small vascular diseases involving small arteries,arterioles,small veins,venules,and capillaries.The imaging findings were lacunar infarction,cerebral microbleeds,cerebral white matter lesions,and perivascular space expansion.In recent years,the incidence of CSVD is increasing,which brings different degree of economic burden to the families and society.It becomes the focus of research at present.The permeability change of blood-brain barrier is the main reason for the onset of CSVD.This article reviews the relationship between the integrity of blood-brain barrier and CSVD.
ABSTRACT
Cerebral microbleeds (CMBs) are a key biomarker of cerebral small vessel disease on magnetic resonance imaging,They have potential clinical relevance to future stroke risk.Therefore,the detection of CMBs has important clinical significance for various cerebrovascular disease phenotypes.This article briefly summarizes the detection method of CMBs,mainly investigating the clinical significance of CMBs in general population and in patients with ischemic stroke,cerebral hemorrhage,vascular cognitive impairment,cerebral amyloid angiopathy,and leukoaraiosis.