Chronic isolated lightheadedness is a sign of abnormal plasma levels of phospholipids.

OBJECTIVE: To evaluate whether Chronic Isolated Light-headedness (CIL) commonly manifested in elderly patients is related with cerebral oxygen insufficiency. METHODS: In this case-control study, 462 patients (aged 40-83 years) with CIL and 238 clinical data matched controls were enrolled consecutively from January 2011 to September 2014. The plasma levels of "phospholipids with solubility similar to that of lysophosphatidic acid" (PSS-LPA), a surrogate marker for cerebral oxygen insufficiency, were assayed for all subjects to compare the occurrence and severity of CIL with the values of PSS-LPA. RESULTS: Patients with CIL had significantly higher plasma levels of PSS-LPA than controls, regardless of having or having not psychogenic abnormalities, χ2 = 448, odds ratio (95% CI) = 140 (72-260), P < 0.001; the mean plasma levels, 0.573 vs. 0.290 mmol/L respectively (P < 0.001). Receiver operator characteristic (ROC) analyses showed plasma PSS-LPA was both sensitive and specific for CIL. The area under ROC curve (AUC) was as high as 0.953 (0.938-0.968). The changes in severity of CIL between two separate assays of one month apart were correlated closely with the changes in plasma levels of PSS-LPA for the same patients, correlation coefficient (Spearman) = 0.90, p < 0.001. CONCLUSIONS: CIL is a manifestation of abnormal plasma levels of phospholipids which suggests cerebral oxygen insufficiency. This new finding shows that cerebral oxygen insufficiency is not rare especially in elderly persons.

The effect of folate and VitB12 in the treatment of MCI patients with hyperhomocysteinemia.

OBJECTIVE: This study aims to investigate the effect of folate combined with VitB12 on serum total homocysteine (tHcy) levels and cognitive function in patients with mild cognitive impairment (MCI) complicated by hyperhomocysteinemia (HHcy). METHODS: (1) A total of 92 MCI patients with HHcy were enrolled in this study and randomly divided into two groups: the intervention group (46 cases) and the control group (46 cases). (2) The patients in both groups received the routine treatment for their condition, but patients in the intervention group were also given 5 mg/day of folate and 500 µg × 3/day of VitB12. (3) The changes in levels of folate, VitB12, and tHcy, the Montreal Cognitive Assessment (MoCA) score and the event-related potential (P300) were observed before and after treatment. RESULTS: (1) There were no statistically significant differences in folate, VitB12, and tHcy levels, the MoCA score and the P300 between the two groups before treatment. (2) At the 4th, 12th and 24th week, folate and VitB12 levels in the intervention group were higher than those in the same group before treatment and those in the control group at the same time points, while tHcy levels were lower than those in the same group before treatment and those in the control group at the same time points. (3) At the 24th week, the MoCA score in the control group was lower than before treatment, and the MoCA score in the intervention group was higher than in the same group before treatment and in the control group at the same time point. The P300 latency was shorter than it was in the same group before treatment and in the control group at the same time point. CONCLUSION: Folate and VitB12 can effectively reduce levels of tHcy in patients with MCI and improve cognitive function.

Association between homocysteine and multivascular atherosclerosis in stroke-related vascular beds determined by three-dimensional magnetic resonance vessel wall imaging.

BACKGROUND: Atherosclerosis in stroke-related vascular beds is the major cause of stroke. Studies demonstrated that multivascular atherosclerosis is prevalent in stroke patients and those with multivascular plaques had higher risk of recurrent stroke. OBJECTIVES: This study investigated the relationship between homocysteine and multivascular atherosclerosis in stroke-related vascular beds using magnetic resonance imaging. METHODS: Patients with recent ischemic cerebrovascular symptoms were enrolled and underwent three-dimensional magnetic resonance vessel wall imaging for intracranial arteries, extracranial carotid arteries and aortic arch. Traditional risk factors and homocysteine were measured. Presence of multivascular plaques defined as plaques in at least two stroke-related vascular beds on magnetic resonance imaging was determined. The relationship between homocysteine and characteristics of multivascular plaques was determined. RESULTS: Of 49 enrolled patients (mean age: 56.3 ±â€¯13.8 years; 35 males), 23 had multivascular plaques. Homocysteine (odds ratio, 1.17; 95% confidence interval, 1.02-1.34; p = 0.022) and age (odds ratio, 1.71; 95% confidence interval, 1.22-2.41; p = 0.002) were significantly associated with presence of multivascular plaques. The adjusted associations remained significant (both p < 0.05). In discriminating presence of multivascular plaques, the area-under-the-curve of age, homocysteine and combination of them was 0.79, 0.70 and 0.87 respectively. CONCLUSIONS: Homocysteine is independently associated with stroke-related multivascular plaques and combination of age and homocysteine has stronger predictive value.

A case report of left atrial myxoma-induced acute myocardial infarction and successive stroke.

RATIONALE: Left atrial myxoma is a common primary cardiac tumor, however, due to poor image quality or atypical myxoma images, it is often misdiagnosed by echocardiograph. A case of left atrial myxoma being misdiagnosed as a thrombus, which successively caused acute myocardial infarction (AMI) and stroke, is very rare. Contrast-enhanced echocardiography can play an important role in definitive diagnosis. PATIENT CONCERNS: A 44-year-old woman was diagnosed AMI because of chest pain with no significant stenosis in the coronary arteries. One month later, the patient was suddenly found unconscious, magnetic resonance imaging (MRI) showed acute multiple cerebral infarctions in the left cerebral hemisphere. DIAGNOSES: Left atrial myxoma, acute myocardial infarction, and stroke. INTERVENTIONS: The patient was given a cardiac surgery for tumor resection, the mass was surgically removed and histopathologic findings showed myxoma. OUTCOMES: After several weeks of rehabilitation, the patient was able to resume daily activities without chest discomfort or dyspnea. One year later, echocardiography showed no recurrence of left atrial myxoma. The patient generally was in good condition. LESSONS: Although myxoma is mostly benign, this patient occurred AMI and stroke because of misdiagnosis. Comprehensive assessments should be performed with multiple imaging methods for cardiac masses. If necessary, contrast-enhanced echocardiography should be used to clarify, so as not to delay the timing of surgery and bring potential risk of death to patients.

Effects of differences in serum total homocysteine, folate, and vitamin B12 on cognitive impairment in stroke patients.

BACKGROUND: Vascular cognitive impairment-no dementia (VCIND) refers to the early or mild cognitive impairment induced by cerebral vascular injury. Research shows that serum total homocysteine (tHcy) level is an independent risk factor for cerebral vascular disease and may be closely related to cognitive function.Current studies on the tHcy level in VCIND patients are limited, and the relationship of tHcy with cognitive function remains unclear. This study aims to investigate the tHcy levels in patients with VCIND and to determine their correlation with cognitive function, as well as to provide useful clues for preventing and treating VCIND. METHODS: The tHcy, folate, and vitamin B12 levels in 82 patients with VCIND were reviewed retrospectively and compared with those of 80 stroke patients without cognitive impairment and 69 healthy controls by using the Montreal Cognitive Assessment (MoCA) scale and the event-related potential P300 to evaluate cognitive function. RESULTS: The tHcy levels in the VCIND group were higher than those in the other two groups, whereas the folate and Vitamin B12 levels in the VCIND group were lower than those of the other two groups. The tHcy levels in the stroke group were higher than those in the control group, and the folate and vitamin B12 levels in the stroke group were lower than those in the control group. The patients in the VCIND group with high tHcy exhibited lower MoCA scores and prolonged P300 latency than those in with normal tHcy. Correlation analysis showed that tHcy level is positively correlated with P300 latency period and negatively correlated with MoCA score. CONCLUSION: The tHcy levels were significantly higher and the vitamin B12 and folate levels were significantly lower in the patients with VCIND than those in the other groups. The high tHcy levels in the VCIND patients may be correlated with impaired cognitive function.

Patients with risk factors have higher plasma levels of lysophosphatidic acid: a promising surrogate marker for blood platelet activation.

Although basic medical studies have shown that lysophosphatidic acid (LPA) has an important relationship to activated blood platelets, we know little about this from clinical experience. This pilot study examined plasma LPA levels in patients with a risk of thrombotic events and evaluated the effects of aspirin on plasma LPA levels. In this basically cross-sectional study, we recruited 1352 patients with either hypertension or hyperlipidemia and 670 controls without any risk factors. Patients with risk factors had significantly higher plasma LPA levels than controls, the mean of LPA = 3.12 ±â€Š2.24 vs. 2.57 ±â€Š1.96 µmol/l, P < 0.001. The patients who had been taking aspirin had relatively lower plasma LPA levels compared with those who did not take aspirin, χ = 43.8, odds ratio (OR) [95% confidence interval (CI)] = 2.76 (2.03-3.75). For the hypertension group, χ = 23.1, OR (95% CI) = 3.44 (2.03-5.82), P < 0.001; for the hyperlipidemia group, χ = 22.9, OR (95% CI) = 2.53 (1.72-3.74), P < 0.001. Patients with a risk factor had higher plasma LPA levels compared with controls. Administration of aspirin may decrease elevated plasma LPA levels. This pilot clinical observation indicates that plasma LPA is worth to be studied further.

Polysomnographic abnormalities in patients with vascular cognitive impairment-no dementia.

OBJECTIVES: We aimed to investigate subjective sleep quality and polysomnographic sleep structure features in patients with vascular cognitive impairment-no dementia (VCIND). METHODS: Fifty-six patients with VCIND, 48 patients with simple stroke (without cognitive impairment), and 48 control subjects were included. The Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG) were used to analyze their sleep characteristics. The Montreal Cognitive Assessment (MoCA) was conducted to assess mental state. RESULTS: Patients with VCIND had higher PSQI scores compared with control subjects and simple stroke patients (P<.01). PSG revealed that patients with VCIND or stroke were more likely to experience prolonged sleep latency (SL), decreased sleep efficiency (SE), increased arousal, and reduced deep sleep and rapid eye movement (REM) sleep than controls. Patients with VCIND had significantly longer SL, increased periodic leg movements in sleep (PLMS), decreased SE, and increased arousal and sleep fragmentation compared to patients with simple stroke (P<.05). In VCIND patients, a significant positive correlation was found between SE and MoCA scores (r=0.632; P<.001), though PSQI, SL, and arousal index were significantly negatively associated with MoCA scores (r=-0.787, -0.740, -0.772, respectively; P<.001 for all). CONCLUSIONS: VCIND patients had different abnormal sleep features, including decreased SE, increased PLMS, and prolonged SL and sleep fragmentation. Abnormal sleep in VCIND may be associated with cognitive impairment.

[A preliminary study on the correlation between clinical makers with the length of patients' hypertension history].

OBJECTIVE: To investigate the correlation between length of hypertension history with plasma level of A Phospholipids Component with the Similar Solubility of Lyso-Phosphatidic Acid (APCSSLPA or briefly AP). So that to farther understand the changes accompanied with prolongation of hypertension history. METHODS: This is a small cross-sectional study. 170 patients with primary hypertension and 79 normal controls without hypertension history were enrolled. The lengths of case history were recorded and compared with their plasma levels of AP. Similar study were also conducted on other 11 clinical makers as references. RESULTS: AP correlated significantly with the length of hypertension history. Correlation coefficient beta is 0.186, P = 0.015. But AP did not correlated significantly with systolic or diastolic pressure of patients. The age of patients did not correlated with AP either (beta = 0.027, P = 0.71). The patient's number with middle or high level of AP was significantly larger in the group in which hypertension history was 10 years or more, than in the group in which hypertension history was less then 10 years. chi(2) = 6.51, P = 0.012. OR = 2.444, 95%CI = 1.219 - 4.903. However, lysophosphatidic acid and other 10 bio-makers which often be used in cerebrovascular and cardiovascular diseases, such as blood lipid, blood sugar, different kinds of lipoprotein and D-dimer etc. did not correlated significantly with hypertension history. CONCLUSION: Comparing with 11 clinical makers, AP was the only one correlated with the length of hypertension history. Our findings suggest: the prolongation of hypertension history may accompanied with increased oxidative damages. The patients with prolonged hypertension history should prevent this possible threaten. Furthermore, AP is a very promising marker with unique worth in cardiovascular and cerebrovascular diseases.

[Level of plasma lysophosphatidic acid in patients with cerebral ischemic attack, a preliminary study].

OBJECTIVE: To study the level of plasma lysophosphatidic acid (LPA) in patients with TIA, cerebral thrombosis or possible ischemic attack. METHODS: Phospholipid was extracted from plasma of patients with TIA, cerebral thrombosis or possible ischemic attack by organic solvent. Lysophosphatidic acid was isolated further. The quantity of LPA was determined by assaying its phosphorous component. RESULTS: LPA level of patients with TIA, cerebral thrombosis or possible ischemic attack were 2.14 +/- 1.02, 1.50 +/- 0.85, and 1.73 +/- 1.14 micromol/L blood plasma respectively, all significantly higher than that in control group (1.00 +/- 0.70 micromol/L, P < 0.05). The plasma LPA level decreased after anticoagulant treatment. CONCLUSION: As a molecular marker released by activated platelets in vivo, plasma PLA may be valuable in diagnosis of cerebral ischemic attack.