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@#Objective To design an interactive and shared electronic database for long-term follow-up management of patients with acute minor stroke (NIHSS≤5) using REDCap,and to explore the value of establishing this database,trying to provide new ideas for clinical treatment. Methods The CRF table of case report was designed according to the relevant data of patients in hospital and the requirements of follow-up management. The nosocomial case data of patients with acute minor stroke (NIHSS≤5) from 3 stroke centers in Shanxi Province were collected and recorded on the CRF form of case reports. An interactive shared electronic database was designed by REDCap,and the data in CRF table were checked and revised and entered into the database. Patients were followed up at 3 months and 1 year after onset. Results Based on REDCap system,a database of acute minor stroke ( NIHSS≤5) in Shanxi Province was established and used in clinical practice. The number of patients expected to be included has been achieved. Its data entry,data quality control,user rights management and data export functions can be stable operation. Conclusion The interactive sharing clinical database of acute minor stroke ( NIHSS≤5) is established by redcap,which has the advantages of simple interface operation,convenient communication,timely entry,and multi-access. It provides a powerful tool for longitudinal data collection,reducing deviation in research,and comprehensively implementing and coordinating project research. It ensures the reliability of research results and has clinical research value.
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@#Objective To explore independent risk factors for early neurological deterioration in first-ever minor ischemic stroke without reperfusion therapy,and to achieve individualized prediction by constructing a nomogram model.Methods We enrolled first-ever minor ischemic stroke patients of non-reperfusion therapy from January 1,2017 to December 31,2019 in the Zhaoqing First People’s Hospital.The clinical and imaging data of the Neurological deterioration group(END group) and the non-END group were analyzed.The independent related factors were screened and the nomogram model was constructed.Results A total of 384 cases were enrolled,including 66 cases (17.19%) in the END group and 318 cases (82.81%) in the non-END group.Logistic regression analysis showed that diabetes mellitus,TOAST typing,albumin levels,and cerebral atherosclerosis score (CAS) were independent influencing factors (P<0.05).The nomogram model is constructed and the ROC curve is generated,and the area under the curve is 0.859［95%CI(0.758,0.864)］.Model consistency can be hinted at by the calibration curve and the Hoster-Lemeshow test.Finally,the clinical decision curve indicates that the model has clinical application value.Conclusion This study explores the nomogram model for END in first-ever minor ischemic stroke without reperfusion therapy,which has some clinical application value,is composed of four major factors:diabetes mellitus,TOAST typing,albumin level and CAS.
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Objective:To explore the efficacy and safety of mechanical thrombectomy (MT) in patients with minor stroke with large vessel occlusion (LVO).Methods:Twenty-three patients with minor stroke with LVO, admitted to our hospital from January 2017 to July 2019, were consecutively collected in our study; patients with contraindications of intravenous thrombolysis should be treated with direct thrombectomy, and the left were given bridging therapy (intravenous thrombolysis combined with MT). NIHSS scores were used to assess the degrees of neurological impairment at admission, and 12 h and 7 d after treatment. Vascular recanalization was assessed by modified cerebral infarction thrombolysis (mTICI) grading, with grading 2B-3 defined as successful recanalization. The prognoses 90 d after treatment were assessed by modified Rankin scale (mRS), and mRS scores≤2 was classified as having good prognosis. Safety indicators included symptomatic intracranial hemorrhage, incidence of complications, and mortality 90 d after treatment.Results:Twenty-two patients had successfully recanalization; 19 patients had mTICI grading 3 and 3 patients had grading 2B. The NIHSS scores were 3 (2, 5) at admission, 2 (2, 3) 12 h after treatment, and 2 (1, 2) 7 d after treatment, with significant difference ( χ2=14.028, P=0.001); NIHSS scores 12 h and 7 d after treatment were significantly lower than those at admission ( P<0.05). Sixteen patients (69.6%) enjoyed good prognosis and 7 patients (30.4%) had poor prognosis. In terms of safety, two patients had symptomatic intracranial hemorrhage,10 had systemic complications, and one died during 90-d of follow-up. Conclusion:MT is effective and safe in minor stroke patients with LVO.
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@#Objective To explore the clinical effect of dl-3-N-butylphthalide（NBP）injection combined with antiplatelet drug therapy and the influence on stroke recurrence of minor stroke patients. Methods A retrospective analysis was performed on 95 patients with minor stroke that admitted to the stoke center of the second affiliated hospital of Harbin Medical University from January to July 2019.It included 45 patients in the combined treatment group （NBP plus antiplatelet treatment group） and 50 patients in the control group （antiplatelet treatment group）. The mRS score，NIHSS score and BI of the two groups were analyzed at 14 days，1 month，3 months and 6 months after treatment. The stroke recurrence events at 1 month，3 months，and 6 months after treatment in both groups will be recorded too. We used multivariate analysis to analyze the factors that might influence stroke recurrence in minor stroke patients. Results ①There was no significant difference in baseline information between the two groups（P>0.05），which was comparable. ②At 14 days，1 month，3 months and 6 months after treatment，the mRS scores and NIHSS scores of the patients in the two groups were significantly lower than that at admission，while the Barthel index were significantly higher than that at admission （P<0.01）. ③In the combined treatment group at 1 month，3 months and 6 months after treatment，the mRS scores were significantly lower than those in the control group （P=0.033，0.031，0.013）. ④The number of the combined treatment group patients with stroke recurrence at 3 months and 6 months after treatment was significantly lower than that in the control group（P=0.033，0.039）. ⑤The results of multivariate analysis showed that using NBP was an independent protective factor in stroke recurrence at 3 months （OR=0.060，95%CI 0.005～0.778，P=0.031） and 6 months （OR=0.163，95%CI 0.028～0.968，P=0.028） for minor stroke. Conclusion NBP combined with antiplatelet drugs can significantly improve the neurological function and reduce the stroke recurrence of minor stroke patients.
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Objective: To investigate the effectiveness and safety of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in patients with minor ischemic stroke. Methods: From April 2016 to January 2018, 117 consecutive patients with acute mild cerebral infarction admitted to the Department of Neurology, Guangzhou First People's Hospital were enrolled retrospectively. Their onset was 0. 05). In the intravenous thrombolysis group, the time from onset to thrombolysis was 75-260 min,and the median time was 161.5 (129.5,185.0) min. (2) There were no significant differences in the NIHSS scores at 24 h and 7 d after treatment between the two groups (P>0.05). Among the patients with good prognosis at 90 d of intravenous thrombolysis,9/10 had good prognosis in patients with disabled stroke symptom and 81.5% (44/54) had good prognosis in those with non-disabled stroke symptom. There was no significant difference in the proportion of good prognosis between the two groups (P =0.512). Among the non-intravenous thrombolysis group with good prognosis at 90 d,8/12 had good prognosis in patients with disabled stroke, and the good prognosis rate in those with non-disabling stroke was 65. 9% (27/41). There was no significant difference in the proportion of good prognosis (P =0.413). The good prognosis rate of the intravenous thrombolytic group at 90 d was higher than that of the non-intravenous thrombolysis group. The difference between the groups was statistically significant (82.8% [53/64] vs. 66. 0% [35/53],χ2 =4. 376,P = 0. 036). (3) In the intravenous thrombolysis group, two patients developed intracerebral hemorrhage transformation during the treatment period;one patient stopped anti-platelet aggregation treatment because of hemorrhage in other parts; one died of intracranial hemorrhage after thrombolytic bridging of cerebrovascular thrombectomy. There were no bleeding and death events during the treatment in the non-intravenous thrombolysis group. There were no significant differences in the incidence of intracerebral hemorrhage transformation and mortality between the two groups (P>0.05). (4) The symptoms in three patients in the intravenous thrombolysis group aggravated, they were treated with the bridge mechanical thrombectomy. Two of them were assessed as non-disabled stroke before thrombolysis, and one patient with carotid artery stenosis underwent carotid artery stent implantation during hospitalization. In the non-intravenous thrombolysis group, 1 patient underwent carotid artery stent implantation and 1 underwent right middle cerebral artery Ml stent implantation. There was no significant difference in the incidence of intracranial macrovascular stenosis, extracranial macrovascular stenosis and total stenosis rate between the two groups (P>0.05). Conclusion: Intravenous thrombolysis is safe and effective for mild ischemic stroke patients with or without disability.
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Objective To investigate the MRI manifestations and analyze the prognostic factors of patients with anterior circulation minor stroke and nonGminor stroke in Qinghai plateau.Methods 41 6 cases of the first admission,including 1 9 2 patients with minor stroke and 224 patients with nonGminor stroke.MRI and MRA examinations of the head were completed in all patients within 72 h of admission.Patients were followed up for one year to observe the recurrence of stroke,and the quality of life was evaluated with the help of modified Rankin Scale (MRS)scores.Results (1)MRA showed that 36.98% of the minor stroke and 58.93% of the nonGminor stroke had the stenosis of the responsible artery at the infarction site.The difference was significant (χ2＝ 1 9.94,P＜ 0.00 1 ).(2 )MRI showed that the initial infarction sites of minor stroke and nonGminor stroke were different (χ2＝4.47 ,P＜0.005 ).(3 )The recurrence rate was 10.42% in minor stroke and 12.05% in nonGminor stroke.There was no significance between the two groups (χ2＝ 0.28,P＞0.05).(4) Among patients with poor prognostic outcomes (whose MRS≥3),there were 1 9 cases of minor stroke and 6 1 cases of nonGminor stroke,and the difference was significant (χ2＝20.00,P＜0.0 1 ).Conclusion LesionGrelated vascular stenosis in patients with minor stroke is mild and the primary infarction is more common in isolated subcortical or deep white matter.The stenosis is severe in patients with nonGminor stroke,and the infarct lesion is often subcortical with or without cortical or deep white matter.There is no difference in recurrence risk between minor stroke and nonGminor stroke.The prognosis of minor stroke is better than that of nonGminor stroke.
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Objective To assess the efficacy and safety of thrombolysis therapy for hyperglycemic patients suffering from minor stroke. Methods Intravenous thrombolysis by rtPA was given to hyperglycemic patients suffering from minor stroke. The recovery of neurological deficits and other clinical parameters were recorded 24 hours ,7 days and 90 days after treatment in randomized thrombolytic group and non-thrombolytic group. Results Neurological recovery rate of minor stroke patients with diabetes in thrombolytic group was higher than that in non-thrombolytic group 24 hours,7 days and 90 days after the treatment(P < 0.05)and the incidence of aggravation or worsening of clinical symptoms in thrombolytic group was lower than that of non-thrombolytic group(P < 0.05). There was no significant difference in the recovery rate of neurological deficits and the incidence of exacerbation or deterioration of clinical symptoms in hyperglycemic patients suffering from minor stroke. No intra-cranial hemorrhage occurred in both groups. Conclusion It is of great significance for minor stroke patients with diabetes to receive intravenous thrombolysis ,which is a safer clinical alternative.
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Objective To assess the efficacy and safety of thrombolysis therapy for hyperglycemic patients suffering from minor stroke. Methods Intravenous thrombolysis by rtPA was given to hyperglycemic patients suffering from minor stroke. The recovery of neurological deficits and other clinical parameters were recorded 24 hours ,7 days and 90 days after treatment in randomized thrombolytic group and non-thrombolytic group. Results Neurological recovery rate of minor stroke patients with diabetes in thrombolytic group was higher than that in non-thrombolytic group 24 hours,7 days and 90 days after the treatment(P < 0.05)and the incidence of aggravation or worsening of clinical symptoms in thrombolytic group was lower than that of non-thrombolytic group(P < 0.05). There was no significant difference in the recovery rate of neurological deficits and the incidence of exacerbation or deterioration of clinical symptoms in hyperglycemic patients suffering from minor stroke. No intra-cranial hemorrhage occurred in both groups. Conclusion It is of great significance for minor stroke patients with diabetes to receive intravenous thrombolysis ,which is a safer clinical alternative.
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Objective To investigate the features of risk factors of minor stroke with CISS classification in Guangdong Province. Methods We retrospectively investigated the patients admitted within 3 days of the occurrence of a minor stroke, and were classified by CISS criteria as large artery atherosclerosis (LAA), cardiogenic stroke (CS), penetrating artery disease (PAD), other etiology (OE), undetermined etiology (UE). Results In this study, 303 pa-tients met the inclusion criteria of minor stroke. The highest percentage of the risk factors included hypertension (72.3%), hyperlipidemia (58.3%), and diabetes mellitus (39.9%). Among different subtypes, 41.9% were diagnosed with LAA, and 50.8% with PAD. Plasma triglyceride (TG)(1.765 ±1.18)mg/L vs.(2.19 ±1.84)mg/L,P=0.03], apolipoproteinsB (ApoB) [(0.95±0.29)mg/L vs.(1.11±0.46)mg/L,P=0.009]C-reactive protein (CRP) [(6.63±11.30) mg/L vs.(3.42 ±5.02)mg/L,P=0.042] and ApoB/ApoA1 ratio [(0.754 ±0.25)mg/L vs.(0.875 ±0.49)mg/L,P=0.019], differed significantly between group LAA and PAD. Conclusion Hypertension, hyperlipidemia and diabetes mellitus are the major risk factors of minor stroke. The most common subtypes of the minor stroke patients in Guangdong Province are LAA and PAD, and detecting their TG, apoB, CRP level and apoB/apoA1 ratio might help subclassify minor stroke according to CISS.
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Objective To study the incidence and risk factors ofdefecatory dysfunction in acute minorischemic strokepatientsandexplore the influence of the risk factors onprognosis.Methods Clinical data of 274 patients with acute minor ischemic strokewere reviewed and analyzed retrospectively.According to the presence of poststroke defecatorydysfunction,they were divided into defecatory dysfunction group and non-defecatory dysfunction group.The factors associated withdefecatory dysfunctionwere analyzed by univariate analysis and multivariatelogisticanalysis respectively,followed by investigating their effects on the prognosis.Results 74 patients of them with acute minor ischemic stroke had defecatory dysfunction.The univariate analysis indicated that4 factors including baseline NIHSS scorewere the risk factors.Multivariate logistic analysis showed that female,age,diabetes mellitus and baseline NIHSS score were independent risk factors for defecatory dysfunction.The scores of modified Rankin Scale (mRS) after 3 months in minor stroke patients with defecatory dysfunction wassignificantly higher(P ＜ 0.05).Baseline NIHSS score was a predictive factor for the prognosis of post-stroke defecatorydysfunctionpatients.Conclusions Defecatory dysfunction in acute minor stroke patients may increase the risk of poor prognosis.The female,elderlypatients as well those with diabetes mellitus and serious neurologicalfunction deficits are more likely to suffer post-stroke defecatory dysfunction.
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Objective To investigate the incidence,characteristics and risk factors of cognitive impairment in patients with transient ischemic attack(TI A) or minor stroke.Methods Montreal cognitive assessment(MoCA) was carried out in 279 patients with TIA or minor stroke and 150 healthy controls to assess their cognitive function.Results (1) Compared with the healthy controls,the TIA/minor stroke patients scored significantly lower on MoCA total score((23.98±2.55) vs (26.60±0.99),t=12.084,P＜0.01) and subtests including visuoexecutive function((3.68±0.94) vs (4.41±0.64),t=8.483,P＜0.01),digital span ((1.81±0.40) vs (1.95±0.23),t=3.771,P＜0.01),attention((0.84±0.37) vs (0.95±0.23),t=3.357,P＜ 0.01),repetition((1.59±0.62) vs (1.89±0.37),t=5.496,P＜0.01),verbal fluency((0.88±0.33) vs (0.95 ± ±0.23),t=2.286,P＜0.05),abstraction((1.55±0.64) vs (1.91±0.34),t=6.357,P＜0.01) and recall ((2.87±1.13) vs (3.18±0.41),t=3.281,P＜0.01) were significantly decreased.(2) Of 279 TIA/Minor stroke patients,213 (76.3％) suffered from cognitive impairment.The incidence of cognitive impairment was positively correlated with the gender,age,educational level,smoking,course,leukoaraiosis,comorbidities such as hypertension,diabetes mellitus(P＜0.05),and negatively correlated with hyperlipidemia(P＞0.05).Conclusion Extensive impairments of cognitive functions occur along with the incidence of TIA or minor stroke.It is thus suggested that cognitive assessment and interventions may be carried out at an early stage.
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Objetive The present study was aimed to explore the risk factors of mid-term cognitive decline in pa?tients with indexed TIA/minor stroke (NIHSS≤3) in a Chinese hospital-based cohort. Methods We recruited all consec?utive Chinese TIA/minor stroke patients from July to December in 2012 and followed them up in stroke clinics at 3 and 18 months after indexed TIA/minor stroke. The outcome was defined as significantly cognitive decline at 18 months com?pared with that at 3 months. Results A total of 209 consecutive Chinese TIA/minor stroke cases completed their fol?low-up investigation. Among them, 24 (11.5%) exhibited significantly cognitive decline. The independent risk factors of cognitive decline post TIA/minor stroke were education years (OR=0.869,P=0.021), atrial fibrillation(OR=5.950, P=0.001) and multiple silent lacunar infarcts (OR=5.179,P=0.020). Conclusion It is necessary to evaluate the cognition among TIA/minor stroke cases and a close follow-up is required for patients with atrial fibrillation and multiple silent la?cunar infarcts frequently in order to decrease the risk of cognitive decline post TIA/minor stroke.
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BackgroundEarly detection of minor strokes and their treatment that aim to prevent from complications into severe strokes is a process of secondary prevention. There is a need to extensively use image diagnostics (CT, MRI) because signs are obscure, at times without focal neurological sign but can have special mental or psychological syndromes. The start of minor stroke studies in Mongolia will enable further deepening of these studies in future and give an impetus to identification of theoreticaland practical aspects together with further improvement of diagnostics, treatment and prevention of minor strokes.GoalTo develop and introduce the diagnostic criteria of ischemic and hemorrhagic minor strokes in accordance to the concepts of minor strokes and to treat minor stokes in order to prevent complications into severe strokes.Materials and MethodCurrently there are no globally accepted diagnostic criteria for minor stroke. We support the 1981 WHO criteria of minor strokes as strokes neurological signs of which disappear in relatively short period of time. There is a general notion that it should mean all light forms of stroke other than severe strokes. In cases of neurological signs of a minor stroke, complete recovery and elimination of the symptoms take up to 3 weeks. Most scholars tend to consider ischemic lacunar strokes (arising from occlusion of arteriole vessels deep in the brain and with size of 0.5-20 mm) as minor strokes. We maintained the concept that characteristic features of these strokes are their limited focal areas and the following neurological symptoms: pure motor, pure sensory, light ataxia, etc. We also duly considered a suggestion (D. German, L. G. Koshchug et al, 2008 ) to define minor hemorrhagic strokes as strokes with diameter less than 2 cm and blood volume less than 5 cm3.We identified 60 patients with minor strokes, involved in monitoring using special research template (with a term of at least 1.5years) and involved in pathogenesis treatment. In the treatment, we maintained a principle of differential diagnosis of ischemic stroke symptoms. Specifically, we differentiated the following: signs related to an atherotromb, cardio-embolic, lacunar, hemodynamic, hemorheologic pathogenesis. To verify the diagnoses, we used MRT and CT image tests. We executed paraclinic tests in order to identify risk factors: Doppler-duplex-sonography, brain angiography, blood lipid fraction, ECG, EchoCG, heart Holter, blood hemorheology test, and identified the most affecting factors (hereditary factors, excess weight, smoking etc).Results: Our study identified the following clinical forms: lacunar stroke, non-lacunar minor stroke, and hemorrhagic minor stroke. Among the minor strokes, the lacunar stroke dominates (48%), the nonlacunar stroke is the next (27.7%), and the hemorrhagic was found to be the least common 25%. From among a host of risk factors, arterial hypertension is dominant (86%) either alone or in combination with such other diseases as diabetes, atherosclerosis etc. Diabetes occurrence was 5 cases (8,3%) which is fewer than in some foreign studies.The clinic of minor stroke also varies. The strength and expression of their symptoms compared with those of severe strokes are unique in the following:- Relatively lighter and recover faster as a result of treatment even in acute forms,- Some are without specific clinical signs (“silent stroke”).- Some minor strokes have micro focal signs, for example, “pure motor”, pure sensory, ataxia etc, in other words, the signs are limited.- In cases of lacunar strokes, predominantly deep brain arterioles are damaged.- Whereas in non-lacun strokes, embolic, ateroma, thrombotic mechanisms are predominant suchas distal branches of big artery. - In cases of hemorrhagic minor strokes, arteriopathy distortions occur not only in depth of brain but also in any small lobar vessels of brain.- Focal lesions have some variations by their pathological locations and minor stroke signs.In non-lacunar strokes (25%), the focal damages predominantly occur in branches of large intra/extra cranial arteries. In cases of lacunars strokes, the focal lesion is not in branches of large intracranial vessels, but is predominantly in basal ganglia, deep white matter, thalamus, pons and in area of deep penetrating arterial vessels. However, focal infarcts in cerebella may occur in any form of minor strokes.ConclusionAccording our study there were identified 3 subtypes of minor stroke. The finding is that lacunars and hemorrhagic minor strokes are more likely to give grounds to severe strokes. From this, it can be concluded that there are specific factors in the population of Mongolia to affect the genesis of minor strokes, namely, arterial hypertension which is directly related with these forms of minor strokes. We appropriate the WHO criteria of minor stroke that is neurological signs of a minor stroke, complete recovery and elimination of the symptoms take up to 3 weeks. In treatment of minor stroke, we suggest that minor strokes should be treating by pathogenetic therapy. Namely, antihypertensive therapy for lacunar infarction, anti-aggregation therapy for nonlacunar infarction and haemostatic and antihypertensive therapy for hemorrhagic minor stroke.
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BACKGROUND: Impairment of cognitive function is often present in patients with carotid artery stenosis but the details of this dysfunction have rarely been reported. Our purpose was to elucidate the cognitive dysfunction in patients with unilateral severe carotid stenosis using comprehensive neuropsychological testing, and also to identify the specific underlying clinical and radiological factors. METHODS: We analyzed the results of neuropsychological testing, the clinical history, and MR findings in 16 consecutive patients with angiographically proven severe (70-99%) stenosis of the extra cranial internal carotid artery (ICA). Cognitive functions were examined using the Seoul Neuropsychological Screening Battery and the Neglect Battery. We excluded patients with cortical infarction and those with contra lateral ICA occlusion or severe stenosis. RESULTS: Our comprehensive neuropsychological testing revealed obvious cognitive deficits in all patients with unilateral severe ICA stenosis, the most common being frontal executive impairment. The mean cognitive score on the memory test was also significantly lower in patients with symptomatic ICA stenosis than in asymptomatic patients (29.33+/-10.98, mean+/-SD, p < 0.05). The total score on the global cognitive test was significantly lower in patients with an ischemic lesion on MRI than in no lesion patients (113.23+/-34.78, p < 0.05). The presence of symptoms related to the ICA stenosis was related to cognitive dysfunction even when there were no ischemic lesions on MRI. SPECT revealed ipsilateral cortical hypoperfusion in 9 of 12 patients (75%). CONCLUSIONS: Cognitive deficits are common in patients with unilateral severe ICA stenosis. Our findings suggest that an additional mechanism beyond the structural lesion such as chronic hypoperfusion may affect cognitive function in patients with high-grade ICA stenosis.