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Chronic cerebral hypoperfusion (CCH) is an important factor leading to vascular cognitive impairment (VCI).It is closely related to small vessel disease such as asymptomatic cerebral infarction and leukoaraiosis.The specific mechanism of VCI remains unclear.The manifestations of CCH are also quite different.This article reviews the relationship between CCH and VCI from animal models,perfusion performance,and pathophysiological mechanisms,etc.
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Objective To investigate the predictors of early neurological deterioration (END) in patients with acute ischemic stroke (AIS). Methods From January 2015 to April 2018, patients with AIS without receiving thrombolytic therapy and endovascular treatment admitted to the Department of Neurology, the First Affiliated Hospital of Nanjing Medical University were collected retrospectively. END was defined as National Institutes of Health Stroke Scale (NIHSS) score increased by ≥2 within 7 days after onset from baseline. The baseline clinical data, imaging examinations, and laboratory findings were compared in patients of the END group and the non-END group. Multivariate logistic regression analysis was used to determine the independent predictors of END. Results A total of 652 patients with AIS were enrolled,including 437 males (67. 0％). There were 247 patients (37. 9％) in the END group and 405 (62. 1％) in the non-END group. There were significant differences in low-density lipoprotein cholesterol, fasting blood glucose, homocysteine, lipoprotein (a), neutrophil percentage, and NIHSS scores between the 2 groups (all P < 0. 05). There were significant differences in the proportion of severity of stroke, serious lesion of the guilty vessels, watershed infarction, etiologic classification of stroke, Oxfordshire Community Stroke Projects classification, and taking statins before onset between the 2 groups (all P < 0. 05 ). Multivariate logistic regression analysis showed that lipoprotein (a) (odds ratio [OR] 1. 001, 95％ confidence interval [CI] 1. 000-1. 002; P = 0. 021), total anterior circulation infarcts (OR 3. 842, 95％CI 1. 383-10. 671; P =0. 003), and partial anterior circulation infarcts (OR 2. 642, 95％CI 1. 486-4. 695; P = 0. 001) were the independent risk factors for END, and prior statin use was an independent protective factor of END (OR 0. 222, 95％CI 0. 072-0. 679; P = 0. 008). Conclusion Lipoprotein (a), total anterior circulation infarcts, and partial anterior circulation infarcts were the independent risk factors for END. Taking statins before onset was an independent protective factor of END.
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Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common monogenic cerebral small vessel disease.Migraine,recurrent subcortical ischemia,progressive cognitive impairment,and emotional disorders are the main features.The diagnosis of CADASIL depends on typical clinical symptoms and neuroimaging findings,and it is confirmed by skin biopsyz and gene testing.In recent years,some new insights have been obtained in the clinical and imaging features of CADASIL This article reviews the research progress in this field.
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Objective To analyze the clinical features and pulmonary radiological findings of primary anti-neutrophil cytoplasmic antibody(ANCA)-associated vasculitis (AAV).Methods Clinical data of 271 ANCA positive primary AAV patients admitted in Shanghai Ruijin Hospital from January 2003 to November 2015 were retrospectively analyzed.Among 271 patients,there were 211 myeloperoxidase (MPO)-ANCA positive cases (MPO subgroup),52 proteinase 3 (PR3)-ANCA positive cases (PR3 subgroup),and 8 dual positive cases (dual subgroup) according to ANCA classification.The demography,clinical characteristics,pulmonary radiological manifestation and renal function were compared among three subgroups.Results MPO subgroup had more renal (x2 =4.968,P =0.026) and constitutional symptoms (x2.=8.901,P =0.003) than PR3 group,while PR3 group had more ENT symptoms (x2 =19.843,P ＜ 0.001),cough (x2 =6.623,P =0.010),hemoptysis (x2 =8.656,P =0.003),dyspnea (x2 =5.127,P =0.024),buccal and ocular mucosal symptoms (x2 =4.818,P =0.028) than MPO group.In lung radiology,interstitial manifestations were displayed more frequently in MPO than PR3 group (x2 =4.237,P =0.040),while pulmonary nodules was more frequent in PR3 than MPO group (x2 =4.503,P =0.034).Dual subgroup tended to have more nervous,respiratory and renal impairment.Renal function showed that MPO subgroup had higher creatinine (Z =-5.529,P ＜ 0.001),urea (Z =-4.646,P ＜ 0.001) and uric acid levels (Z =-2.331,P =0.020) than PR3 subgroup.Dual subgroup had higher creatinine (Z =-3.251,P =0.001) and urea (Z =-2.882,P =0.004) levels than PR3 subgroup,but there was no difference with MPO subgroup.Conclusion There are significant differences in both clinical and pulmonary radiological manifestations between the MPO and PR3-ANCA subgroup of primary AAV.
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<p><b>OBJECTIVE</b>To analyze the clinical features and genetic cause for a family affected with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL).</p><p><b>METHODS</b>Clinical manifestations, neuroimaging, and genetic analysis were performed.</p><p><b>RESULTS</b>The main clinical features have included stroke, emotional disturbance and history of migraine without progressive memory impairment. A positive family history was confirmed. Cranial MRI has revealed multi-infarct lesions and white matter hyperintensity involving bilateral basal ganglia, subcortex and brain stem. All such features were in keeping with the diagnosis of CADASIL. A rare 2182C>T mutation in exon 14 of the NOTCH3 gene was identified in all available cases.</p><p><b>CONCLUSION</b>Both clinical and molecular features suggested that the family has been affected with CADASIL.</p>