Hemorrhagic Cerebrovascular Disease: An Unusual Presentation of Hyperhomocysteinemia / Accidente cerebrovascular hemorrágico: una inusual presentación de hiperhomocisteinemia / Acidente vascular cerebral hemorrágico: uma apresentação incomum da hiper-homocisteinemia

Introduction: Stroke is a major cause of morbidity and mortality worldwide, with hemorrhagic stroke being the deadliest form of acute stroke. Therefore, the cause of the event should be determined to direct the associated therapy and take preventive measures. Hyperhomocysteinemia has been described as a rare etiology of stroke. Although hyperhomocysteinemia has been associated with venous thrombotic events, altered endothelial function, and procoagulant states, its clinical role in stroke remains controversial. Case description: We present a case of a 60-year-old male patient with primary autoimmune hypothyroidism who presented with dysarthria, facial paresis, and left upper-limb monoparesis after sexual intercourse. A simple skull computed tomography scan showed hyperintensity in the right basal ganglion, indicating an acute hemorrhagic event. Etiological studies were performed, including ambulatory blood pressure monitoring, cerebral angiography, and transthoracic echocardiogram, which ruled out underlying vascular pathology. During follow-up, vitamin B12 deficiency and hyperhomocysteinemia were detected, without other blood biochemical profile alterations. Supplementation was initiated, and homocysteine levels gradually decreased, without new neurological deficits observed during follow-up. Conclusion: Quantification of homocysteine should be considered in patients with a cerebrovascular disease without apparent cause, as documenting hyperhomocysteinemia and correcting its underlying etiology are essential not only for providing appropriate management but also for preventing future events.

Introducción: el accidente cerebrovascular es una causa importante de morbilidad y mortalidad en todo el mundo, y el accidente cerebrovascular hemorrágico es la forma más mortífera de accidente cerebro- vascular agudo. La determinación de la causa del evento es esencial para dirigir la terapia asociada y poder tomar medidas preventivas. La hiperhomocisteinemia se ha descrito como una etiología poco frecuente de accidente cerebrovascular. Aunque esta se ha asociado con eventos trombóticos venosos, disfunción endotelial alterada y estados procoagulantes, sigue siendo controvertido su papel clínico en el accidente cerebrovascular. Descripción del caso: se presenta el caso de un hombre de 60 años con hipotiroidismo autoinmune primario que presentó disartria, paresia facial y monoparesia del miembro superior izquierdo después de un encuentro sexual. Una simple tomografía computarizada de cráneo mostró hipointensidad en la región del ganglio basal derecho, que indicaba un evento hemorrágico agudo. Se realizaron estudios etiológicos, incluyendo monitorización ambulatoria de la presión arterial, angiografía cerebral y ecocardiograma transtorácico, que descartaron patología vascular subyacente. Durante el seguimiento, se detectó deficiencia de vitamina B12 e hiperhomocisteinemia, sin otras alteraciones en el perfil bioquímico sanguíneo. Se inició la suplementación y los niveles de homocisteína disminuyeron gradualmente, sin observar nuevos déficits neurológicos durante el seguimiento. Conclusión: la cuantificación de homocisteína debe ser considerada en casos de enfermedad cerebrovascular sin causa aparente, dado que documentar la hiperhomocisteinemia y corregir su etiología subyacente es esencial no solo para proporcionar un manejo adecuado, sino también para prevenir eventos futuros.

Introdução: o acidente vascular cerebral (AVC) é uma das principais causas de morbidade e mortalidade em todo o mundo, sendo o AVC hemorrágico a forma mais letal de AVC agudo. A determinação da causa do evento é essencial para direcionar a terapia associada e poder tomar medidas preventivas. A hiperhomocisteinemia tem sido descrita como uma etiologia rara de acidente vascular cerebral. Embora a hiper-homocisteinemia tenha sido associada a eventos trombóticos venosos, disfunção endotelial alterada e estados pró-coagulantes, seu papel clínico no AVC permanece controverso. Descrição do caso: apresentamos o caso de um homem de 60 anos com hipotireoidismo autoimune primário que apresentou disartria, paresia facial e monoparesia do membro superior esquerdo após relação sexual. A tomografia computadorizada de crânio mostrou hipointensidade na região do gânglio da base direito, indicando evento hemorrágico agudo. Foram realizados estudos etiológicos, incluindo monitorização ambulatorial da pressão arterial, angiografia cerebral e ecocardiograma transtorácico, que descartaram patologia vascular subjacente. Durante o acompanhamento, foram detectados deficiência de vitamina B12 e hiper-homocistei- nemia, sem outras alterações no perfil bioquímico sanguíneo. A suplementação foi iniciada e os níveis de homocisteína diminuíram gradualmente, sem novos déficits neurológicos observados durante o acompanhamento. Conclusão: a quantificação da homocisteína deve ser considerada em casos de doença vascular cerebral sem causa aparente, pois documentar a hiper-homocisteinemia e corrigir sua etiologia subjacente é essencial não apenas para fornecer manejo adequado, mas também para prevenir eventos futuros.

The effects of the healthcare line in a stroke unit: three years' experience of a center in the Northeast of Brazil / Efeitos da linha de cuidado em saúde em uma unidade de AVC: três anos de experiência de um centro no nordeste do Brasil

Abstract Background Treatment at an organized stroke unit center (SUC) improves survival after stroke. Stroke mortality has decreased worldwide in recent decades. Objective This study shows the experience of a SUC in the Northeast of Brazil, comparing its first, second, and third years. Methods We compared data on the SUC prospectively collected from 31 July 2018 to 31 July 2019 (year 1), August 1st, 2019, to July 31st, 2020 (year 2), and August 1st to July 31st, 2021 (year 3). Results There was an expertise evolution through the years, with good outcomes in spite of the coronavirus disease 2019 pandemic in the 3rd year. Also, in the 1st year, the median (interquartile range) door-to-needle time was 39.5 (29.5-60.8) minutes evolving to 22 (17-30) minutes, and then to 17 (14-22) minutes in the last year. Conclusion This was the first report on a SUC's outcome in the Brazil's Central Arid Northeast countryside, and it shows the improvement in care for patients with stroke through an effective healthcare line.

Resumo Antecedentes O tratamento em um centro organizado com Unidade de acidente vascular cerebral (AVC) melhora a sobrevida após o AVC. A mortalidade por AVC diminuiu em todo o mundo nas últimas décadas. Objetivo Este estudo mostra a experiência de um centro de AVC no Nordeste brasileiro, comparando o primeiro, segundo e terceiro anos do serviço. Métodos Nós comparamos dados coletados prospectivamente na Unidade de AVC de 31 de julho de 2018 a 31 de julho 2019 (ano 1), 1° de agosto de 2019 a 31 de julho de 2020 (ano 2) e 1° de agosto a 31 de julho de 2021 (ano 3). Resultados Houve uma evolução na conhecimento especializado ao longo dos anos, com bons desfechos apesar da pandemia de coronavirus disease 2019 no terceiro ano. Além disso, no primeiro ano a mediana do tempo porta-agulha foi de 39.5 (29.5-60.8) minutos, evoluindo para 22 (17-30) minutos, e então 17 (14-22) minutos no último ano. Conclusão Este foi o primeiro relato sobre o desempenho de um serviço de AVC do interior do Nordeste brasileiro e evidencia a melhoria assistencial aos pacientes com AVC por meio de uma efetiva linha de cuidado em saúde.

Comportamiento de variables epidemiológicas y clínicas de pacientes con infarto cerebral en Villa Clara

Fundamento la enfermedad cerebrovascular representa el problema de salud más frecuente relacionado con la atención neurológica, hecho en que estriba la importancia que reviste su estudio en los diferentes contextos y desde diversos enfoques. Objetivo describir el comportamiento de variables epidemiológicas y clínicas en pacientes ingresados por infarto cerebral. Métodos estudio descriptivo y transversal, realizado en el servicio de Neurología del Hospital Arnaldo Milián Castro, de Villa Clara, Cuba, el cual incluyó a todos los pacientes con diagnóstico clínico de infarto cerebral cardioembólico o aterotrombótico, ingresados en sala durante el año 2019. La información se obtuvo de las historias clínicas almacenadas en el Archivo del Hospital; y fue procesada en el paquete estadístico SPSS. v. 21. Se aplicó un análisis estadístico descriptivo, en una distribución de frecuencias. Resultados predominaron los pacientes del sexo femenino (51,6 %). Hubo mayor incidencia en hombres mayores de 79 años (47,7 %), y en mujeres mayores de 70 (86,0 %). En el 67,3 % se demostró la causa cardioembólica. La hipertensión arterial resultó el principal factor de riesgo asociado (83,6 %). El defecto motor se observó como hallazgo clínico más frecuente al ingreso (96,7 %). Se identificaron la transformación hemorrágica del infarto y la bronconeumonía nosocomial como principales complicaciones neurológicas y no neurológicas respectivamente. Prevalecieron los pacientes egresados vivos (68,6 %). Conclusiones los ictus isquémicos son más frecuentes en pacientes de edad avanzada; la identificación temprana y manejo oportuno de la enfermedad instaurada puede prevenir en gran medida la aparición de complicaciones, y consecuentemente la muerte.

Background cerebrovascular disease represents the most common health problem related to neurological care, it is important to study it in different contexts and from different approaches. Objective to describe epidemiological and clinical variables' behavior in patients admitted for stroke. Methods descriptive and cross-sectional study, carried out in Arnaldo Milián Castro Hospital's Neurology service from Villa Clara, Cuba, which included all patients with a clinical diagnosis of cardioembolic or atherothrombotic stroke, admitted to the ward during 2019. The information was obtained from the medical records stored in the Hospital Archive; and it was processed in the statistical package SPSS. v. 21. A descriptive statistical analysis was applied, in a frequency distribution. Results female patients predominated (51.6%). There was a higher incidence in men older than 79 years (47.7%), and in women older than 70 (86.0%). In 67.3% the cardioembolic cause was demonstrated. Arterial hypertension was the main associated risk factor (83.6%). The motor defect was observed as the most frequent clinical finding on admission (96.7%). Hemorrhagic transformation of the infarct and nosocomial bronchopneumonia were identified as the main neurological and non-neurological complications, respectively. Patients discharged alive prevailed (68.6%). Conclusions ischemic strokes are more frequent in elderly patients; early identification and timely management of the established disease can largely prevent the appearance of complications, and consequently death.

Comportamiento de indicadores relacionados con la asistencia a pacientes con hemorragia subaracnoidea espontánea en la provincia de Cienfuegos

Fundamento: la importancia sanitaria de la hemorragia subaracnoidea espontánea, como problema de salud, es un hecho reconocido. Objetivo determinar el comportamiento de algunos indicadores relacionados con la asistencia médica a pacientes con hemorragia subaracnoidea espontánea, en el contexto provincial. Métodos estudio observacional, descriptivo-correlacional y retrospectivo, de 96 pacientes con hemorragia subaracnoidea espontánea entre 2016 y 2021. Se analizó el comportamiento de indicadores seleccionados, en su relación con diversas variables. En el análisis estadístico se utilizó como estadígrafo el Odds Ratio y su intervalo de confianza. Resultados el 22 % de los pacientes fue diagnosticado pasadas las primeras 48 horas del inicio de los síntomas, mientras que 13 enfermos (14 %) requirieron más de una asistencia para el diagnóstico. La ocurrencia de diagnóstico tardío cuando no se identificó el sangramiento en la primera consulta fue significativa (OR 21,8[5,1;91,8]). Doce pacientes fueron admitidos fuera de unidades especializadas; esta situación se observó más en pacientes menores de 60 años (21% vs 4 %; OR 5,7[1,1;27,9]), y en quienes el diagnóstico se realizó después de las 48 horas del inicio de las manifestaciones (29 % vs 8 %; OR 4,6[1,3;16,2]). De los 35 pacientes trasladados a otra institución para tratamiento neuroquirúrgico solo cuatro (12 %) fueron evacuados en las primeras 72 horas. Conclusiones se identifican brechas en la atención al paciente con hemorragia subaracnoidea en el contexto provincial; se destacan el ingreso de enfermos fuera de unidades especializadas y el traslado tardío a instituciones con servicio de cirugía neurovascular.

Background: the spontaneous subarachnoid hemorrhage's health importance, it's recognized as a health problem. Objective: to determine the behavior of some indicators related to medical care for patients with spontaneous subarachnoid hemorrhage, in the provincial context. Methods: Observational, descriptive-correlational and retrospective study of 96 patients with spontaneous subarachnoid hemorrhage between 2016 and 2021. The behavior of selected indicators was analyzed in relation to various variables. In the statistical analysis, the Odds Ratio and its confidence interval were used as statisticians. Results: 22% of the patients were diagnosed after the first 48 hours after the onset of symptoms, while 13 patients (14%) required more than one assistance for diagnosis. The occurrence of late diagnosis when bleeding was not identified at the first visit was significant (OR 21.8[5.1;91.8]). Twelve patients were admitted outside of specialized units; this situation was observed more in patients under 60 years of age (21% vs 4%; OR 5.7[1.1;27.9]), and in whom the diagnosis was made 48 hours after the onset of manifestations (29% vs 8%; OR 4.6[1.3;16.2]). Of the 35 patients transferred to another institution for neurosurgical treatment, only four (12%) were evacuated in the first 72 hours. Conclusions: gaps are identified in the patients' care with subarachnoid hemorrhage in the provincial context; The admission of patients outside specialized units and the late transfer to institutions with neurovascular surgery service stand out.

Study of Incidence of Ponticulus Posterior In Dry Human Atlas Vertebra and Its Clinical Significance

Background: Atlas is the first cervical vertebra. The vertebral artery lies in the groove on posterior arch of the atlas. The vertebral artery groove may sometimes get converted into a foramen. This is commonly known as ponticulus posterior (ponticulus posticus) or arcuate foramen of the atlas. These foramina may be complete or incomplete. This can lead to compression of the vertebral artery and produce symptoms like headache, syncope, altered consciousness etc. It can also complicate manipulations of the cervical spine by reducing the blood flow during extreme rotations of head and neck. It is also associated with vertebrobasilar artery stroke So, neurosurgeons or orthopaedic surgeons who operate in this area should have a detailed knowledge of variations of groove for the vertebral artery. Materials and Methods: The present study was conducted on 50 dried and fully ossified adult human atlas of unknown age and sex collected from the department of Anatomy, Government Medical college, Nagpur. Each atlas vertebra was carefully observed for the presence or absence of complete or incomplete ponticuli on superior surface of posterior arch of atlas. Results: Out of the 50 vertebra studied 7(14%) showed the presence of Ponticuli. Ponticuli were incomplete in all 7 atlas vertebras. Complete ring was not observed in any of the atlas vertebra .Out of the 7 ponticuli 6(12%) were found to be unilateral and in only 1 (2%) case it was found to be bilateral. Out of the 6 ponticuli 4(8%) were noticed on the Left side and 2(4%) were present on the right side. Conclusion: Presence of incomplete ponticulus posterior might cause cervical pain and even cerebrovascular disorders due to pressure on third part of vertebral artery present in the vertebral artery groove. This anatomical knowledge is important for neurosurgeons, orthopaedic surgeons, radiologists and clinicians while dealing with this region.

Indicadores Socioeconômicos e Mortalidade por Doença Isquêmica do Coração e Doença Cerebrovascular no Brasil de 2000 a 2019 / Socioeconomic Indicators and Mortality from Ischemic Heart Disease and Cerebrovascular Disease in Brazil from 2000 to 2019

Resumo Fundamento: Estudos prévios identificaram desigualdade na variação das taxas de mortalidade por doença isquêmica do coração (DIC) e doença cerebrovascular (DCBV) quando comparadas regiões com diferentes níveis de indicadores de desenvolvimento socioeconômico. Objetivo: Analisar a variação das taxas de mortalidade por DIC e DCBV e do desenvolvimento econômico, avaliado pelos índices sociodemográfico (ISD) e de vulnerabilidade social (IVS) no Brasil, em um período de 20 anos. Métodos: Estudo ecológico de séries temporais das taxas de mortalidade bruta e padronizada (método direto com a população brasileira de 2000) por DIC e DCBV por sexo e UF entre 2000 e 2019 comparadas com o ISD e com o IVS. Resultados: Houve melhora do ISD e IVS concomitante a redução da taxa de mortalidade padronizada por faixa etária por DIC e por DCBV no país, entretanto isso ocorreu de modo desigual entre as unidades federativas (UFs). As UFs com melhores indicadores socioeconômicos obtiveram maior redução nas taxas de mortalidade. Discussão: A variação das taxas de mortalidade por DIC e DCBV em comparação com a variação do desenvolvimento socioeconômico são compatíveis com estudos prévios, mas vamos além ao comparar de modo concomitante com o ISD e o IVS. As limitações são o fato de ser um estudo observacional, trabalhar com bancos de dados e estar sujeito ao viés ecológico. Conclusão: Os dados observados levantam a hipótese de que a melhora das condições socioeconômicas é um dos fatores responsáveis pela redução das taxas de mortalidade por DIC e DCBV.

Abstract Background: Previous studies have identified inequalities in the variation of mortality rates from ischemic heart disease (IHD) and cerebrovascular disease (CBVD) when comparing regions with different levels of socioeconomic development indicators. Objective: To analyze the variation in IHD and CBVD mortality rates and economic development, evaluated by the sociodemographic index (SDI) and social vulnerability index (SVI) in Brazil over a period of 20 years. Methods: Ecological study of time series of crude and standardized mortality rates (direct method, based on the Brazilian population in year 2000) from IHD and CBVD by sex and Federative Unit (FU) between 2000 and 2019, compared using the SDI and SVI. Results: There was an improvement in SDI and SVI concomitantly to a reduction in age-standardized mortality rate from IHD and CBVD in the country; however, this occurred unevenly across the FUs. The FUs with the best socioeconomic indicators had the greatest reduction in mortality rates. Discussion: The variations in mortality rates from IHD and CBVD, compared using variations in socioeconomic development, are aligned with those from previous studies, but the present study goes further by including the indicators SDI and SVI in the comparison. The limitations include the observational nature of the study, the use of databases, and the vulnerability to ecological bias. Conclusion: The observed data raise the hypothesis that the improvement in socioeconomic conditions is one of the factors responsible for the reduction in mortality rates from IHD and CBVD.

Dilated optic nerve sheath by ultrasound predicts mortality among patients with acute intracerebral hemorrhage / A bainha do nervo óptico dilatada na ultrassonografia prediz mortalidade na hemorragia intraparenquimatosa aguda

Abstract Background Intracerebral hemorrhage (ICH) is a deadly disease and increased intracranial pressure (ICP) is associated with worse outcomes in this context. Objective We evaluated whether dilated optic nerve sheath diameter (ONSD) depicted by optic nerve ultrasound (ONUS) at hospital admission has prognostic value as a predictor of mortality at 90 days. Methods Prospective multicenter study of acute supratentorial primary ICH patients consecutively recruited from two tertiary stroke centers. Optic nerve ultrasound and cranial computed tomography (CT) scans were performed at hospital admission and blindly reviewed. The primary outcome was mortality at 90-days. Multivariate logistic regression, ROC curve, and C-statistics were used to identify independent predictors of mortality. Results Between July 2014 and July 2016, 57 patients were evaluated. Among those, 13 were excluded and 44 were recruited into the trial. Their mean age was 62.3 ± 13.1 years and 12 (27.3%) were female. On univariate analysis, ICH volume on cranial CT scan, ICH ipsilateral ONSD, Glasgow coma scale, National Institute of Health Stroke Scale (NIHSS) and glucose on admission, and also diabetes mellitus and current nonsmoking were predictors of mortality. After multivariate analysis, ipsilateral ONSD (odds ratio [OR]: 6.24; 95% confidence interval [CI]: 1.18-33.01; p = 0.03) was an independent predictor of mortality, even after adjustment for other relevant prognostic factors. The best ipsilateral ONSD cutoff was 5.6mm (sensitivity 72% and specificity 83%) with an AUC of 0.71 (p = 0.02) for predicting mortality at 90 days. Conclusion Optic nerve ultrasound is a noninvasive, bedside, low-cost technique that can be used to identify increased ICP in acute supratentorial primary ICH patients. Among these patients, dilated ONSD is an independent predictor of mortality at 90 days.

Resumo Antecedentes A hemorragia intraparenquimatosa (HIP) aguda apresenta elevada morbimortalidade e a presença de hipertensão intracraniana (HIC) confere um pior prognóstico. Objetivo Avaliamos se a dilatação do diâmetro da bainha do nervo óptico (DBNO) através do ultrassom do nervo óptico (USNO) na admissão hospitalar seria preditora de mortalidade. Métodos Estudo multicêntrico e prospectivo de pacientes consecutivos com HIP supratentorial primária aguda admitidos em dois centros terciários. Ultrassom do nervo óptico e tomografia computadorizada (TC) de crânio foram realizados na admissão e revisados de forma cega. O desfecho primário do estudo foi a mortalidade em 3 meses. Análises de regressão logística, curva de característica de operação do receptor (ROC, na sigla em inglês) e estatística-C foram utilizadas para identificação dos preditores independentes de mortalidade. Resultados Entre julho de 2014 e julho de 2016, 44 pacientes foram incluídos. A idade média foi 62,3 (±13,1) anos e 12 (27,3%) eram mulheres. Na análise univariada, o volume da HIP na TC de crânio, DBNO ipsilateral à HIP, glicemia, escala de coma de Glasgow (ECG) e NIHSS na admissão hospitalar, e também diabetes mellitus e não-tabagista foram preditores de mortalidade. Após análise multivariada, o DBNO ipsilateral à HIP permaneceu como preditor independente de mortalidade (odds ratio [OR]: 6,24; intervalo de confiança [IC] de 95%: 1,18-33,01; p = 0,03). O melhor ponto de corte do DBNO ipsilateral como preditor de mortalidade em 3 meses foi 5,6mm (sensibilidade 72% e especificidade 83%) e área sob a curva (AUC, na sigla em inglês) 0,71 (p = 0,02). Conclusão O USNO é um método não-invasivo, beira-leito, de baixo custo, que pode ser empregado para estimar a presença de HIC em pacientes com HIP supratentorial primária aguda. A presença de DBNO dilatada é um preditor independente de mortalidade em 3 meses nesses pacientes.

Risk factors of cardiovascular and cerebrovascular diseases in young patients with hyperhomocysteinemia / 中国基层医药

Objective:To investigate the risk factors of cardiovascular and cerebrovascular diseases in young patients with hyperhomocysteinemia.Methods:A total of 260 patients younger than 45 years old who received treatment at the Department of Emergency, Seventh Medical Center, Chinese PLA General Hospital from January 2018 to January 2019 were included in this study. Among these patients, 126 patients with serum homocysteine levels ≥ 15.0 μmol/L were included in the hyperhomocysteinemia group, and 134 patients with serum homocysteine levels < 15.0 μmol/L were included in the control group. Height, body weight, body mass index, blood pressure, homocysteine, fasting blood glucose, blood uric acid, total cholesterol, triacylglycerol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and N-terminal B-type natriuretic peptide were determined in each group. Changes in risk factors of cardiovascular and cerebrovascular diseases were compared between the hyperhomocysteinemia and control groups.Results:There were significant differences in body mass index [(26.42 ± 3.54) kg/m 2vs. (22.14 ± 3.22) kg/m 2, t = 10.21, P = 0.016], blood uric acid [(308.71 ± 78.44) μmol/L vs. (285.05 ± 92.09) μmol/L, t = 2.22, P = 0.027], the incidence of coronary heart disease (73/126 vs. 61/134, χ2 = 4.00, P = 0.045) and the incidence of stroke (19/126 vs. 6/134, χ2 = 8.39, P = 0.004) between the hyperhomocysteinemia and control groups. There were no significant differences in fasting blood glucose, blood lipid level, N-terminal B-type natriuretic peptide, and the incidences of diabetes mellitus and hypertension between the two groups (all P > 0.05). Conclusion:The related risk factors of cardiovascular and cerebrovascular diseases increase in young patients with hyperhomocysteinemia. The incidences of coronary heart disease and stroke are very high, and therefore timely intervention should be carried out.

Effect of dual task walking on spatiotemporal gait in patients with cerebral small vessel disease / 中华神经科杂志

Objective:To compare the gait characteristics of cognitive and motor dual task walking (DTW) in patients with cerebral small vessel disease (CSVD), and determine the best gait parameters to diagnose CSVD and judge the severity of the disease.Methods:A total of 106 patients with CSVD and 21 healthy individuals were included from September 1, 2020 to July 1, 2021 in the Seventh Medical Center of Chinese People′s Liberation Army General Hospital. According to the Fazekas scores, the subjects were divided into mild ( n=34, 1 point), moderate ( n=34, 2 points), severe ( n=38,3 points) groups and control group ( n=21). Participants were recorded parameters under single task walking (STW) and DTW conditions, and calculated dual task effect (DTC) through the difference between single task and dual task. The differences in gait variances and their DTC were shown by generalized estimation equations when performed in STW and DTW and 4 groups of the severity of disease. Post-hoc comparisons were corrected using Bonferroni′s method. Spearman analyses were applied to explore the correlations between gait parameters and their DTC during STW or DTW and severity of disease. Based on the Logistic model, combining predictors or probabilities were gained and applied to establish receiver operating characteristic curve in order to calculate sensitivity, specificity, and the area under the curve. Results:In the control group, there was no statistically significant difference in gait parameters between STW and DTW. In the CSVD group, the gait parameters of STW were significantly better than cognitive or motor DTW (all P<0.05). In the control group, there was no statistically significant difference in basic gait parameters under different tasks (all P>0.05). In cognitive DTW, temporal gait parameters (stride frequency and stride time) deteriorated significantly only in moderate and severe groups [stride frequency:moderate group 100.220±1.795/min,severe group 94.525±2.139/min;stride time:moderate group (1.227±0.024) s, severe group (1.299±0.031) s], but spatial parameters [stride length: control group (1.050±0.021) m, mild group (0.974±0.022) m, moderate group (0.903±0.025) m, severe group (0.793±0.026) m; stride speed: control group (0.944±0.028) m/s, mild group (0.866±0.030) m/s, moderate group (0.751±0.027) m/s, severe group (0.606±0.022) m/s] were significantly different among all groups (except the control group and mild group;all P<0.05). The DTC of all gait parameters during cognitive DTW was higher than that during motor DTW (all P<0.05) for CSVD patients. While no any difference was found between cognitive DTW and motor DTW in the control group (all P>0.05). Similarly, the temporal parameters′ DTC of cognitive DTW was abnormal only in the late stage of disease, while the spatial parameters′ DTC showed statistically significant difference among all the groups (including the control group and the mild group;all P<0.05). Correlation coefficients of the spatial parameters and their DTC in condition of cognitive DTW were significantly higher than temporal parameters and their DTC (0.50< r<0.64 vs 0.15< r<0.39). The area under curve of the combined predictor was significantly higher than that of any single index. Conclusions:Cognitive DTW can better reflect the abnormal gait of CSVD patients. The spatial parameters and DTC of cognitive DTW could effectively diagnose CSVD and distinguish the disease of severity. And DTC might be better indicators. For diagnosis of CSVD, there was no significant discrepancy between the spatial parameters and DTC, but the combined predictor could significantly improve the sensitivity and reduce the false negative rate.

Relationship between intracranial arterial remodeling and imaging markers in patients with cerebral small vessel disease / 中华神经科杂志

Objective:To investigate the relationship between intracranial arterial remodeling and imaging markers in patients with cerebral small vessel disease (CSVD).Methods:One hundred and fifty-six patients with CSVD who were admitted to the Department of Neurology of the Second Affiliated Hospital of Zhengzhou University or the Public People′s Hospital of Xinzheng from January 2020 to May 2022 were selected, and their brain artery remodeling (BAR) score was calculated. The patients with BAR score≤-1 standard deviation (SD) were defined as individuals with constrictive remodeling of intracranial arteries, and the patients with BAR score≥1 SD were defined as individuals with dilated remodeling of intracranial arteries. Imaging markers of CSVD [white matter hyperintensities (WMHs), lacune, cerebral microbleeds, enlarged perivascular spaces, and cerebral atrophy] were quantified, total CSVD load was calculated and patients were divided into low load group (0-2 points, n=91) and high load group (3-4 points, n=65) according to the total CSVD load scores. The correlation between intracranial artery remodeling and various imaging markers of CSVD and total load was analyzed by using univariate analysis and binary Logistic regression analysis. A nomogram prediction model was established and a receiver operating characteristic curve (ROC) was drawn to assess the predictive value of intracranial artery remodeling on high total CSVD load. Results:Dilated intracranial arterial remodeling was an independent influence factor on severe WMHs ( OR=3.66, 95% CI 1.38-9.72, P=0.009), lacune ( OR=3.78, 95% CI 1.17-12.19, P=0.026), cerebral atrophy ( OR=3.11, 95% CI=1.10-8.81, P=0.033), and high total CSVD load ( OR=6.66, 95% CI=2.14-20.77, P=0.001). Age was an independent influencing factor for high total CSVD load ( OR=1.12, 95% CI 1.07-1.16, P<0.01). A nomogram prediction model for high total CSVD load with age and BAR score≥1 SD as dependent variables had a good effect (C-index=0.826) and calibration ( P=0.024). The best cut-off point of ROC curve was 0.50, with an area under the curve of 0.83 (95% CI 0.76-0.89, P<0.01), the sensitivity and specificity of 0.72 and 0.82. Conclusions:Patients with dilated intracranial arterial remodeling may have a heavier CSVD load. Dilated intracranial arterial remodeling may serve as a new biomarker for assessing CSVD, but the mechanism of the association needs further study.

Fibroblast growth factor 23 and cerebrovascular diseases / 国际脑血管病杂志

Fibroblast growth factor 23 (FGF23) is a bone-derived hormone that plays a central role in the regulation of calcium, phosphorus and active vitamin D levels. Recent studies have shown that high FGF23 is associated with cardiocerebrovascular diseases. This article reviews the correlation between FGF23 and cerebrovascular diseases.

Gut microbiota and cerebral vessel diseases / 国际脑血管病杂志

Gut microbiota is involved in maintaining intestinal homeostasis. The bidirectional communication between intestinal flora and brain can also be conducted through the neuro-immune-endocrine network, namely, the "microbiota-gut-brain axis". A number of studies have shown that the "microbiota-gut-brain axis" disorder plays an important role in the occurrence, development and prognosis of some cerebrovascular diseases, such as cerebral small vessel disease and stroke. This article introduces the latest research progress of the relationship between gut microbiota and cerebrovascular diseases, so as to provide more ideas and options for the treatment of cerebrovascular diseases.

IScore, a useful prognostic tool for patients with acute ischemic stroke treated with intravenous thrombolysis: a validation study / IScore, uma ferramenta prognóstica útil para pacientes com AVC isquêmico submetidos a trombólise: estudo de validação

Abstract Background Stroke is one of the major causes of disability and mortality worldwide. Up to 30% of individuals who experience stroke die within 30 days, and more than 50% of those who survive will have some degree of disability. There are some predetermining factors based on admission data that could be used to objectively assess the odds of poor outcomes, including the Ischemic Stroke Predictive Risk Score (IScore). Objective To analyze and validate the IScore in patients undergoing intravenous thrombolysis for stroke and compare the results of this predictor with actual death and disability outcomes. Methods In a retrospective study, data were collected from a database housed at the Stroke Unit of the Teaching Hospital of Universidade Federal do Paraná, Southern Brazil. The IScore was applied to admission data from 239 patients, and the results were compared with actual outcomes (death and disability) within 30 days and 1 year after the stroke event. Data analysis was performed using an analysis of the receiver operating characteristic (ROC) curve to determine the sensitivity and specificity of the IScore in the study population. Results The IScore demonstrated moderate sensitivity and high specificity in patients with stroke who underwent thrombolysis when evaluated after 30 days and 1 year of the event. Conclusions The IScore can be applied to in stroke patients undergoing thrombolysis; therefore, it may be used as an objective prognostic tool to guide clinical decision-making. Understanding the prognosis of patients in the acute phase can assist clinicians in making the best therapeutic decisions and enable better end-of-life care.

Resumo Antecedentes O acidente vascular cerebral (AVC) é uma das principais causas de morte e incapacidade no mundo. Até 30% dos indivíduos evoluem a óbito nos primeiros 30 dias. Dos sobreviventes, mais da metade ficam com alguma sequela. Certas variáveis identificadas já na admissão podem sinalizar maior risco de desfecho desfavorável. Uma dessas ferramentas prognósticas é a Escala de Previsão de Riscos de AVC Isquêmico (Ischemic Stroke Predictive Risk Score, IScore, em inglês). Objetivo Analisar e validar a aplicação do IScore em pacientes com AVC isquêmico submetidos a trombólise endovenosa e comparar os resultados obtidos com a aplicação da escala aos verdadeiros desfechos de morte e incapacidade funcional. Métodos Trata-se de um estudo retrospectivo, cujos dados foram obtidos do banco de dados da Unidade de AVC do Hospital de Clínicas da Universidade Federal do Paraná. A IScore foi aplicada conforme os dados de admissão de 239 pacientes. Os pacientes foram acompanhados ambulatorialmente, e os resultados da escala foram comparados aos desfechos reais de mortalidade e incapacidade. Os resultados foram demonstrados por meio da curva característica de operação do receptor (receiver operating characteristic, ROC, em inglês) para determinar sensibilidade e especificidade da escala. Resultados Em pacientes com AVC submetidos a trombólise, a IScore demonstrou moderada sensibilidade e alta especificidade para predizer desfechos tanto de óbito quanto de incapacidade, nos intervalos de 30 dias e 1 ano após o evento. Conclusões A IScore pode ser aplicada em pacientes com AVC isquêmico, na população específica submetida a trombólise; portanto, pode ser usada como uma ferramenta prognóstica útil, que pode guiar decisões terapêuticas. Entender o prognóstico de paciente na fase aguda pode auxiliar os clínicos a fazer as melhores decisões terapêuticas e possibilitar melhores cuidados ao fim da vida.

Riesgo de enfermedad cardiovascular y cerebrovascular a largo plazo en mujeres con antecedente personal de abrupción placentaria

La salud materna y perinatal es una de las prioridades actuales de la salud global. La enfermedad cardiovascular y el accidente cerebrovascular son las principales causas de mortalidad materna. La abrupción placentaria sigue siendo una preocupación crítica para la morbilidad materna debido a que se ha asociado a enfermedad vascular a largo plazo. Sin embargo, no existe mucha literatura disponible en español ni evidencia reciente que haya dilucidado algunas interrogantes sobre este tópico. Entonces, el objetivo de esta revisión consiste en sintetizar evidencia reciente sobre el riesgo de enfermedad cardiovascular y cerebrovascular a largo plazo en mujeres con antecedente personal de abrupción placentaria. Se encontró que, a través de mecanismos fisiopatológicos complejos, que involucran la estructura y funcionalidad de la red vascular placentaria con posterior extensión de lesión vascular y producción de factores proinflamatorios y procoagulantes que permanecen después del parto, se precipita la aparición de eventos cardiovasculares mayores a mediano y largo plazo. Evidencia de alta calidad ha revelado que el riesgo de sufrir de complicaciones maternas en aquellas mujeres con abrupción placentaria es de 2,14, que se eleva aún más para aquellas con desprendimiento severo. A mediano y largo plazo, el riesgo de mortalidad por cardiopatía coronaria es de 2,64, y de 1,70 para desorden cerebrovascular, con igual riesgo tanto para el tipo isquémico como hemorrágico. Entonces, se puede concluir que el riesgo cardiovascular y cerebrovascular es inminente en mujeres con antecedente de abrupción placentaria, dado por numerosos mecanismos fisiopatológicos vasculares. No obstante, este riesgo se eleva considerablemente al asociarse con factores modificables tradicionales y no tradicionales.

Maternal and perinatal health is one of today's global health priorities. Cardiovascular disease and stroke are the leading causes of maternal mortality. Placental abruption remains a critical concern for maternal morbidity because it has been associated with long-term vascular disease. However, there is neither much literature available in Spanish nor recent evidence elucidating some questions on this topic. Thus, this review aims to synthesize recent evidence on the long-term risk of cardiovascular and cerebrovascular disease in women with a personal history of placental abruption. It was found that, through complex pathophysiological mechanisms involving the structure and functionality of the placental vascular network with subsequent extension of vascular injury and production of proinflammatory and procoagulant factors which remain after delivery, major cardiovascular events are precipitated in the medium and long term. High-quality evidence has shown that the risk of maternal complications in women with placental abruption accounts for 2.14, rising even higher for those with severe placental abruption. In the medium and long term, the mortality risk caused by coronary heart diseases is 2.64 and by cerebrovascular disorders is 1.70, with equal risk for both ischemic and hemorrhagic strokes. It can therefore be concluded that cardiovascular and cerebrovascular risk is imminent in women with a history of placental abruption due to a number of vascular pathophysiological mechanisms. However, this risk is considerably increased when associated with traditional and non-traditional modifiable factors.

Deterioro cognitivo de origen vascular y demencia vascular esporádica: revisión narrativa de tema basada en la evidencia / Cognitive impairment of vascular origin and sporadic vascular dementia: an evidence-based narrative topic review

RESUMEN INTRODUCCIÓN: La enfermedad cerebrovascular y las demencias están unidas por el deterioro cognitivo y la demencia vascular. Se trata de condiciones de salud potencialmente prevenibles, capaces de generar discapacidad, especialmente en la población adulta mayor. METODOLOGÍA: El propósito de este trabajo es caracterizar el deterioro cognitivo vascular y el espectro de la demencia vascular esporádica, mediante una revisión de tema con énfasis neurocognitivo. RESULTADOS: Entre el 30 % y el 40 % de las personas con enfermedad cerebrovascular experimentan algún grado de compromiso cognitivo. Después de los tres meses de haber presentado una enfermedad cerebro-vascular, alrededor del 20 % al 30 % de los pacientes serán diagnosticados con demencia, y entre un 10 % y un 35 %, con deterioro cognitivo. El deterioro cognitivo vascular y la demencia vascular tienen una serie de factores comunes a la enfermedad cerebrovascular y a la enfermedad de Alzheimer. La demencia vascular presenta subtipos: la demencia multiinfarto, caracterizada por varios infartos cerebrales que se acumulan en el tiempo; la demencia por infarto estratégico, en la que hay infartos localizados en zonas cortico-subcorticales con gran conectividad; y la demencia por enfermedad isquémica de pequeñas arterias, producida por infartos lacunares o lesiones difusas de sustancia blanca, que afecta principalmente la velocidad de procesamiento y las funciones ejecutivas. CONCLUSIONES: El deterioro cognitivo en personas con enfermedad cerebrovascular involucra pérdidas en el rendimiento de una o varias funciones mentales superiores, situación que puede evolucionar hasta la demencia, en la que un déficit permanente en las funciones mentales afecta de manera importante el desempeño y el funcionamiento. Sin embargo, es un tema que permite hablar y promover activamente el control o la modificación de factores de riesgo cardiovascular.

ABSTRACT INTRODUCTION: Cerebrovascular disease and dementias are linked by cognitive impairment and dementia of vascular origin. Potentially preventable health conditions capable of generating disability, especially in the older adult population. METHODOLOGY: The purpose is to characterize the cognitive impairment of vascular origin and the spectrum of sporadic vascular dementia, through a review of the topic with a neurocognitive emphasis. RESULTS: Between 30 % to 40 % of people with cerebrovascular disease acquire some degree of cognitive impairment. After three months of having experienced a cerebrovascular disease, about 20 % to 30 % of patients will be diagnosed with dementia and between 10 % and 35 % with cognitive impairment. Vascular cognitive impairment and vascular dementia have several factors common to cerebrovascular disease and Alzheimer's disease. Vascular dementia has subtypes: multi-infarct dementia characterized by several cerebral infarcts that accumulate over time; dementia due to strategic infarction, where there are infarcts located in cortico-subcortical areas with great connectivity; and dementia due to ischemic disease of the small arteries, produced by lacunar infarcts or diffuse lesions of the white matter, which mainly affect processing speed and executive functions. CONCLUSIONS: Cognitive impairment in people with cerebrovascular disease involves losses in the performance of one or several higher mental functions, a situation that can evolve to dementia, where a permanent deficit in mental functions significantly affects performance and functioning. However, it is a topic that allows to speak and actively promote the control and / or modification of cardiovascular risk factors.

Complicaciones agudas hospitalarias en adultos mayores con Enfermedad Cerebrovascular asociadas a características neuro-geriátricas / Acute hospital complications in older adults with Cerebrovascular Disease associated with neurogeriatric characteristics

INTRODUCCIÓN: La enfermedad cerebrovascular en los adultos mayores tiene implicaciones clínicas, sociales y económicas que pueden comprometer la funcionalidad y la calidad de vida. Es importante determinar las complicaciones que puede presentar el paciente geriátrico con enfermedad cerebrovascular durante los días de estancia hospitalaria. OBJETIVO: Determinar las características neuro-geriátricas asociadas a las complicaciones agudas no neurológicas y los días de hospitalización de los pacientes adultos mayores con enfermedad cerebrovascular. MATERIALES Y MÉTODOS: Estudio descriptivo prospectivo. Población de 120 y muestra de 73 pacientes mayores de 65 años con enfermedad cerebro vascular de la Unidad de Neurología del Hospital Carlos Andrade Marín que inició en agosto de 2020 y culminó en enero 2021. Se excluyó a pacientes que no cumplieron el criterio mencionado, con dependencia funcional total previa, patologías psiquiátricas previas, o personas que no aceptaron ser parte del estudio. Se efectuó el seguimiento de los pacientes desde el ingreso hasta el alta hospitalaria, para identificar complicaciones agudas no neurológicas y días de hospitalización. Se determinó las características neuro-geriátricas mediante las escalas de Barthel, Gijón, Charlson, Norton, Glasgow y NIHSS. Se obtuvo riesgo relativo e intervalos de confianza, considerando significativo un valor p<0,05. RESULTADOS: La edad media fue de 77 (±8,5) años. Las complicaciones fueron infección de tracto urinario (22,0%), neumonía (20,0%), desequilibrio hidroelectrolítico (19,0%), disfagia (13,0%) y úlceras por presión (9,0%). Las complicaciones que se presentaron significativamente ante una estancia hospitalaria prolongada comparada con quienes no las presentaron fueron la Neumonía (Media 5,81 (1,47 a 10,16) con IC 95%) y la infección del tracto urinario (Media 4,95 (1,52 a 8,38) con IC 95%). Según las características neuro-geriátricas y las complicaciones, encontramos diferencia estadísticamente significativa solo con en el grupo de riesgo bajo, según la escala de Norton RR 0,744 con IC 95% (0,584 - 0,949). CONCLUSIONES: Es importante realizar la valoración geriátrica integral al paciente neurológico tanto al ingreso como al egreso hospitalario, ya que permite detectar complicaciones que pueden pasar desapercibidas y prolongar la estancia hospitalaria.

INTRODUCTION: Cerebrovascular disease in older adults has clinical, social, and economic implications that can compromise functionality and quality of life. It is important to determine the complications that the geriatric patient with cerebrovascular disease may present during hospital days. OBJECTIVE: To determine the neuro-geriatric characteristics associated with acute non-neurological complications and hospital days in older adult patients with cerebrovascular disease. MATERIALS AND METHODS: Prospective descriptive study. Population of 120 and sample of 73 patients older than 65 years with cerebrovascular disease from the Neurology Unit of the Carlos Andrade Marín Hospital that began in August 2020 and culminated in January 2021. Patients who did not meet the aforementioned criteria, with previous total functional dependence, previous psychiatric pathologies, or people who did not agree to be part of the study were excluded. Patients were followed up from admission to hospital discharge to identify acute non-neurological complications and days of hospitalization. Neuro-geriatric characteristics were determined using the Barthel, Gijon, Charlson, Norton, Glasgow and NIHSS scales. Relative risk and confidence intervals were obtained, considering a p-value <0.05 as significant. RESULTS: Mean age was 77 (±8.5) years. Complications were urinary tract infection (22.0%), pneumonia (20.0%), water and electrolyte imbalance (19.0%), dysphagia (13.0%) and pressure ulcers (9.0%). Complications that occurred significantly in the face of a prolonged hospital stay compared to those who did not present were Pneumonia (Mean 5.81 (1.47 to 10.16) with 95% CI) and urinary tract infection (Mean 4.95 (1.52 to 8.38) with 95% CI). According to neuro-geriatric characteristics and complications, we found statistically significant difference only with in the low risk group, according to the Norton scale RR 0.744 with 95% CI (0.584 - 0.949). CONCLUSIONS: It is important to perform comprehensive geriatric assessment of the neurological patient both on admission and hospital discharge, as it allows the detection of complications that may go unnoticed and prolong hospital stay.

Moyamoya disease and syndrome: a review / Doença e síndrome de moyamoya: uma revisão

Abstract Moyamoya disease is a chronic occlusive cerebrovascular disease that is non-inflammatory and non-atherosclerotic. It is characterized by endothelial hyperplasia and fibrosis of the intracranial portion of the carotid artery and its proximal branches, leading to progressive stenosis and occlusion, often clinically manifesting as ischemic or hemorrhagic stroke with high rates of morbidity and mortality. On cerebral angiography, the formation of collateral vessels has the appearance of a puff of smoke (moyamoya in Japanese), which became more conspicuous with the refinement of modern imaging techniques. When there is associated disease, it is known as moyamoya syndrome. Treatments are currently limited, although surgical revascularization may prevent ischemic events and preserve quality of life. In this review, we summarize recent advances in moyamoya disease, covering aspects of epidemiology, etiology, presentation, imaging, and treatment strategies.

RESUMO A doença de moyamoya, ou doença cerebrovascular oclusiva crônica, é uma afecção não inflamatória e não aterosclerótica, caracterizada por hiperplasia endotelial e fibrose dos segmentos intracranianos das artérias carótidas internas e da porção proximal de seus ramos. Isso provoca estenose progressiva e oclusão, frequentemente manifestada clinicamente como isquemia cerebral ou hemorragia intracraniana, com alta morbimortalidade. A formação compensatória de vasos colaterais produz, na angiografia encefálica, um aspecto de nuvem de fumaça (moyamoya, em japonês). Quando existe doença subjacente que possa estar relacionada, a doença recebe o nome de síndrome de moyamoya. Embora a incidência esteja aumentando graças aos novos métodos diagnósticos, as estratégias terapêuticas ainda são limitadas. O diagnóstico precoce permite cirurgias de revascularização cerebral que podem evitar novos acidentes vasculares e melhorar a qualidade de vida. Nesta revisão são apresentados os avanços recentes sobre a doença de moyamoya, citando aspectos de epidemiologia, etiologia, apresentação, exames diagnósticos e tratamento.

The correlation between total magnetic resonance imaging burden and middle cerebral artery pulsatility index in elderly patients with cerebral small vessel diseases / 中华神经科杂志

Objective:To explore the correlation between middle cerebral artery (MCA) pulsatility index (PI) and total magnetic resonance imaging (MRI) burden in elderly patients with cerebral small vessel diseases (CSVD).Methods:A total of 203 CSVD inpatients aged 60 years and above who were hospitalized in the Department of Neurology of Hebei General Hospital from March 2017 to December 2020 were enrolled. The clinical data, transcranial Doppler ultrasound parameters and brain MRI data were collected. According to the total burden score, the patients were divided into low burden group (0-1 point) and high burden group (2-4 points). Univariate and multivariate Logistic regression analysis was used to analyze the correlation between MCA PI and total MRI burden in the elderly patients with CSVD. Subsequently, the receiver operating characteristic curve was used to evaluate the value of MCA PI for predicting the high MRI burden of CSVD in the elderly.Results:Hypertension ( OR=2.569, 95% CI 1.068-6.182, P=0.035), systolic blood pressure ( OR=1.033, 95% CI 1.006-1.061, P=0.016), creatinine ( OR=1.044, 95% CI 1.009-1.079, P=0.013) and MCA PI ( OR=1.125, 95% CI 1.087-1.166, P<0.001) were independently correlated with the increasing total MRI burden in the elderly patients with CSVD. Spearman rank correlation analysis revealed that there was strong and positive correlation between MCA PI and high MRI burden in the elderly patients with CSVD ( r=0.65, P<0.001). The analysis showed that when the cut-off for MCA PI was 1.11, it could identify high MRI burden of CSVD in the elderly. The area under the curve was 0.908 (95% CI 0.864-0.953, P<0.001). The sensitivity and specificity were 0.852 and 0.880, respectively. The positive predictive value was 92.38%, and the negative predictive value was 77.70%. Conclusion:The MCA PI is positively correlated with total MRI burden in the elderly patients with CSVD, and has a higher value in predicting the total MRI burden in the elderly CSVD patients, which probably bring brighter prospects for its clinical application.

Carotid atherosclerosis and vascular cognitive impairment / 国际脑血管病杂志

Carotid atherosclerosis (CAS) is closely associated with the decline of cognitive function in the elderly, which can lead to persistent or progressive cognitive function and neurological dysfunction. Vascular cognitive impairment (VCI) is considered to be an intervenable disease. Studies have shown that CAS is one of the main causes of VCI. Further study on the relationship between CAS and VCI will help to better prevention and treatment of VCI.

Microglia: a potential intervention target for vascular cognitive impairment / 国际脑血管病杂志

Microglia are the main innate immune cells in the central nervous system, which play a variety of roles in the development of the central nervous system and the occurrence of diseases. Recent studies have found that microglia play an important role in the occurrence and development of vascular cognitive impairment (VCI), which can lead to cognitive decline by activating neuroinflammation, oxidative stress, and destroying the blood-brain barrier. This article reviews the role of microglia in the pathophysiology of VCI, aiming to provide a new basis for targeting microglia to treat VCI.