Dynamic Structural and Functional Reorganizations Following Motor Stroke.

BACKGROUND The combined effects of bilateral corticospinal tract (CST) reorganization and interhemispheric functional connectivity (FC) reorganization on motor recovery of upper and lower limbs after stroke remain unknown. MATERIAL AND METHODS A total of 34 patients underwent magnetic resonance imaging (MRI) examination at weeks 1, 4, and 12 after stroke, with a control group of 34 healthy subjects receiving 1 MRI examination. Interhemispheric FC in the somatomotor network (SMN) was calculated using the resting-state functional MRI (rs-fMRI). Fractional anisotropy (FA) of bilateral CST was recorded as a measure of reorganization obtained from diffusion tensor imaging (DTI). After intergroup comparisons, multiple linear regression analysis was used to explore the effects of altered FA and interhemispheric FC on motor recovery. RESULTS Interhemispheric FC restoration mostly occurred within 4 weeks after stroke, and FA in ipsilesional remained CST consistently elevated within 12 weeks. Multivariate linear regression analysis showed that the increase in both interhemispheric FC and ipsilesional CST-FA were significantly correlated with greater motor recovery from week 1 to week 4 following stroke. Moreover, only increased FA of ipsilesional CST was significantly correlated with greater motor recovery during weeks 4 to 12 after stroke compared to interhemispheric FC. CONCLUSIONS Our results show dynamic structural and functional reorganizations following motor stroke, and structure reorganization may be more related to motor recovery at the late subacute phase. These results may play a role in guiding neurological rehabilitation.

Structural and functional reorganization following unilateral internal capsule infarction contribute to neurological function recovery.

PURPOSE: To investigate proliferative reorganization in the bilateral corticospinal tract (CST) and functional reorganization in the sensorimotor network (SMN) after internal capsule stroke, and to examine the significance of this reorganization. METHODS: We recruited 17 patients with first-onset acute stroke (16 male, 1 female, mean age 52 ± 10 years) and 17 age- and sex-matched healthy controls. We excluded patients aged < 18 or > 65 years and those with lesions outside the unilateral internal capsule. All subjects underwent diffusion tensor imaging and resting-state functional MRI on days 7, 30, and 90 from symptom onset. We measured fractional anisotropy (FA) in the CST, interhemispheric functional connectivity (FC) within the SMN, and pre-MRI clinical scores, including the National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), and Fugl-Meyer (FM). Correlations among the changes in FA, FC, and clinical scores were analyzed. RESULTS: From day 7 to 90 after stroke, FA in the bilateral CST increased (ipsilesional side, Pinternal capsule = 0.009, Pcentrum semiovale = 0.001; contralesional side, Pinternal capsule = 0.006, Pcentrum semiovale = 0.017), as did FC (P < 0.05); NIHSS scores decreased (P < 0.05), while FM and BI progressively increased (P < 0.05). Increased FA in bilateral CST was negatively correlated with decreased NIHSS scores. Increased FA in only the ipsilesional side was positively correlated with increased FM. Increased FC was positively correlated only with increased BI. CONCLUSION: Proliferative reorganization in the CST and functional reorganization in the SMN support and promote neurological functional recovery after internal capsule infarction.

A clinical research on the potential pathogenesis of somatic cancer related cerebral venous sinus thrombosis.

To investigate the pathogenesis of somatic solid cancer-related cerebral venous sinus thrombosis (CVST).A total of 174 patients with CVST were recruited from the hospital between January 2006 and December 2017 and divided into two groups: (1) somatic cancer-related CVST group, defined as active somatic solid cancer patients with acute CVST; (2) cancer group (CG), defined as active somatic solid cancer patients without CVST. The cancer group patients were age and gender-matched somatic cancer-related CVST group patients. In addition, the types and amount distribution of cancer in cancer group were also matched with somatic cancer-related CVST group patients.Compared to cancer group patients, somatic cancer-related CVST group patients had more intracranial metastasis, a higher platelet count, higher plasma D-dimer, carcinoembryonic antigen (CEA) and cancer antigen (CA) 125 levels, a greater platelet to lymphocyte ratio (PLR), and a greater platelet to neutrophil ratio (PNR). The risk for CVST in somatic cancer-related CVST group patients increased independently by 0.7% (odds ratio [OR] 1.007; 95% confidence interval [CI] 1.000, 1.015; P = .047) with a 1 ng/ml increase in D-dimer levels, by 4.6% (OR 1.046; 95% CI 1.011, 1.083; P = .010) with a 1 U/ml increase in CEA, by 2.7% (OR 1.027; 95% CI 1.003, 1.051; P = .025) with a 1 U/ml increase in CA125, and by 10.6% (OR 1.106; 95% CI 1.002, 1.220; P = .045) with a 1 unit increase in PNR.It was suggested that together impacts of elevated plasma D-dimer, CA125, CEA levels, and a greater PNR may lead to hypercoagulability and to trigger the development of cancer-related CVST.

Cerebral hemorrhage as the initial manifestation in patients with systemic cancer.

BACKGROUND: Cerebral hemorrhage as well as ischemic stroke is one of the common complications among patients with cancer. Ischemic stroke could be the initial manifestation in some patients with cancer. Meanwhile, some patients with cancer also could present cerebral hemorrhage as the initial manifestation, and further studies are required to determine whether these patients have their unique clinical features. AIM: To investigate the clinical features and underlying pathogenesis of concealed systemic cancer patients with cerebral hemorrhage as the initial manifestation. METHODS: The clinical data of patients with concealed systemic cancer who presented cerebral hemorrhage as the initial manifestation registered at the First Affiliated Hospital of Guangxi Medical University from January 2010 to December 2015 were prospectively collected and analyzed. RESULTS: Seventeen systemic cancer patients with cerebral hemorrhage as the initial manifestation (0.02%) were ultimately enrolled from 8,326 patients with cerebral hemorrhage. Three patients had traditional risk factors, but the other 14 patients did not. The common subtypes of malignancy were lung cancer, liver cancer, gastric carcinoma, rectal cancer and melanoma. Most patients (11/17, 64.7%) had elevated plasma levels of cancer biochemical markers, including cancer antigen (CA)125, CA153 and CA199, carcino-embryonic antigen, and alpha fetal protein. Coagulopathy was observed in 15 patients. CONCLUSION: The concealed systemic cancer patients with cerebral hemorrhage as the initial manifestation may lack conventional vascular risk factors but did present coagulopathy and elevated plasma levels of cancer biochemical markers. Coagulopathy might be responsible for the cerebral hemorrhage.

Potential Pathogenesis and Biomarkers of Kidney Cancer-Related Stroke.

BACKGROUND Stroke risk and stroke recurrence are increased in cancer patients, but the pathogenesis and biomarkers of kidney cancer-related stroke (KCS) are generally unclear. The aim of the present research was to investigate the pathogenesis and plasma biomarkers of kidney cancer-related stroke. MATERIAL AND METHODS A retrospective review was conducted on acute stroke patients with kidney cancer (KC) who were admitted to the hospital between January 2006 and December 2015. A total of 106 patients with KCS (active KC patients with acute stroke but without conventional vascular risks) were identified. In addition, 106 age- and sex-matched patients with KC alone were recruited. RESULTS KCS patients had higher plasma D-dimer, cancer antigen (CA) 125, and CEA levels and greater proteinuria levels than did KC patients. Multiple logistic regression analysis showed that the risk of stroke in patients with KC increased independently by 0.8% (odds ratio [OR] 1.008; 95% confidence interval [CI] 1.002, 1.013; p=0.004) with a 1 ng/mL increase in D-dimer levels, by 1.2% (OR 1.012; 95% CI 1.007, 1.018; p=0.000) with a 1 U/mL increase in CA125, by 2.5% (OR 1.025; 95% CI 1.012, 1.038; p=0.000) with a 1 U/mL increase in CEA by 1.4% (OR 1.014; 95% CI 1.005, 1.024; p=0.004) with a 1 mg increase in urine protein in 24 hours. CONCLUSIONS Elevated plasma D-dimer, CA125 and CEA levels, and increased urine protein levels might lead to hypercoagulability and then KCS; however, they may also be biomarkers of KCS.

[Clinical characteristics of acute cerebral hemorrhage in patients with systemic malignancy].

OBJECTIVE: To investigate the clinical features of systemic malignancy patients with acute cerebral hemorrhage as well as its underlying mechanism. METHODS: The clinical data, including presentation, lab tests and neurological images, of systemic malignancy patients with acute cerebral hemorrhage at the First Affiliated Hospital of Guangxi Medical University between January 2003 and December 2014 were collected and analyzed. RESULTS: Among 61 326 systemic malignancy patients, 25 patients(0.04%)were found with acute cerebral hemorrhage and were enrolled. Out of these 25 patients, age ranged from 31 to 77 years old, with an average age of 61 years, 18 patients were males. The clinical features of the systemic malignancy patients with acute cerebral hemorrhage were found that most patients (14/25, 54.0%) lacked traditional risk factors, with sudden symptom onset and some degree of neurologic deficiency in all patients, and most hemorrhagic lesions (19/25, 76.0%) involved the hemicerebrum, for most patients (16/25, 60.0%) cerebral hemorrhage occurred after 3 days to 3 years of the malignancy diagnosis, and some malignancy patients (8/25, 32.0%) presented with cerebral hemorrhage as the first presentation. The common subtypes of malignancy found were lung cancer (8/25, 32.0%), liver cancer (7/25, 28.0%), and then gastric carcinoma (6/25, 24.0%). Most patients (22/25, 88.0%) had elevated plasma level of cancer biochemical marks (including one or more than one of cancer antigen 125, 153 and 199, carcino-embryonic antigen, and alpha fetal protein), most patients (16/25, 64.0%) were found to have coagulation disorder. CONCLUSIONS: The unique clinical features of the systemic malignancy patients with acute cerebral hemorrhage are most patients lacking traditional risk factors, with coagulation disorder and with hemorrhagic lesions in hemicerebrum. And coagulation disorder might be responsible for the cerebral hemorrhage.

Clinical Features of Liver Cancer with Cerebral Hemorrhage.

BACKGROUND Cerebral hemorrhage is common in patients with cancer, but the clinical features and pathogenesis of liver cancer patients with cerebral hemorrhage are not well known. MATERIAL AND METHODS Liver cancer patients who developed cerebral hemorrhage were recruited from the First Affiliated Hospital of Guangxi Medical University between January 2003 and December 2014. We retrospectively analyzed clinical presentations, results of laboratory tests, and imaging examinations. The clinical features and pathogenesis were summarized. RESULTS Among 11133 patients with liver cancer, 9 patients (0.08%), including 3 females and 6 males met the inclusion criteria. The age range was 48-73 years and the average age was 61.67±8.97 years. Five patients did not have traditional hemorrhage risk factors and 4s had the risk factors; however, all had developed hepatocellular carcinoma, and 3 had developed metastasis. All 9 patients showed elevated tumor markers: an increased AFP level was detected in 6 patients, coagulation dysfunctions in 8 patients, and abnormal liver functions in 6 patients. Five patients had developed cerebral hemorrhagic lesions in the lobes of their brains, while hemorrhagic lesions in the basal ganglia occurred in 3 patients and in the brainstem in only 1 patient. Four patients had clear consciousness, while 5 patients were in coma and showed poor prognosis. CONCLUSIONS Patients who have liver cancer complicated with cerebral hemorrhage usually lack traditional risk factors of cerebral hemorrhage. The site of cerebral hemorrhage is often detected in the lobes of the brain. Coagulation dysfunctions might be the main pathogenesis of liver cancer complicated with cerebral hemorrhage.

Tongxinluo Enhances Neurogenesis and Angiogenesis in Peri-Infarct Area and Subventricular Zone and Promotes Functional Recovery after Focal Cerebral Ischemic Infarction in Hypertensive Rats.

Background. Tongxinluo is a traditional Chinese medicine compound with the potential to promote the neuronal functional recovery in cerebral ischemic infarction. Objective. This study aimed to disclose whether tongxinluo promotes neurological functional recovery and neurogenesis and angiogenesis in the infarcted area and SVZ after cerebral ischemic infarction in hypertensive rats. Methods. The ischemic model was prepared by distal middle cerebral artery occlusion (MCAO) in hypertensive rats. Tongxinluo was administrated 24 h after MCAO and lasted for 3, 7, or 14 days. Behavioral tests were performed to evaluate the protection of tongxinluo. Immunochemical staining was applied on brain tissue to evaluate the effects of tongxinluo on neurogenesis and vascularization in the MCAO model rats. Results. Postinjury administration of tongxinluo ameliorated the neuronal function deficit in the MCAO model rats. As evidenced by the immunochemical staining, BrdU(+)/DCX(+), BrdU(+)/nestin(+), and BrdU(+) vascular endothelial cells were promoted to proliferate in SVZ after tongxinluo administration. The matured neurons stained by NeuN and vascularization by laminin staining were observed after tongxinluo administration in the peri-infarct area. Conclusion. Tongxinluo postischemia administration could ameliorate the neurological function deficit in the model rats. Possible mechanisms are related to neurogenesis and angiogenesis in the peri-infarct area and SVZ.