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Jun Lu,1,&ast; Huiqing Pan,1,&ast; Jingjing Xing,1 Bing Wang,1 Li Xu,2 Sheng Ye1,3 1Emergency Department, The Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, People’s Republic of China; 2Neurology Department, The Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, People’s Republic of China; 3School of Clinical Medicine, Wannan Medical College, Wuhu, Anhui, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Sheng Ye, Emergency Department, The Second Affiliated Hospital of Wannan Medical College, 10 Kangfu Road, Jinghu District, Wuhu, Anhui, People’s Republic of China, Email yesheng0553@163.comBackground: A considerable proportion of hypertensive patients may experience lacunar infarction. Therefore, early identification of the risk for lacunar infarction in hypertensive patients is particularly important. This study aimed to develop and validate a concise nomogram for predicting lacunar infarction in hypertensive patients.Methods: Retrospectively analyzed the clinical data of 314 patients with accurate history of hypertension in the Second Affiliated Hospital of Wannan Medical College from January 2021 to December 2022. All the patients were randomly assigned to the training set (n=220) and the validation set (n=94) with 7:3. The diagnosis of lacunar infarction in patients was confirmed using cranial CT or MRI. The independent risk factors of lacunar infarction were determined by Least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression analysis. The nomogram was built based on the independent risk factors. The nomogram’s discrimination, calibration, and clinical usefulness were evaluated by receiver operating characteristics (ROC) curve, calibration curve, and decision curve analysis (DCA) analysis, respectively.Results: The incidence of lacunar infarction was 34.50% and 33.00% in the training and validation sets, respectively. Five independent predictors were made up of the nomogram, including age (OR=1.142, 95% CI: 1.089– 1.198, P< 0.001), diabetes mellitus (OR=3.058, 95% CI: 1.396– 6.697, P=0.005), atrial fibrillation (OR=3.103, 95% CI: 1.328– 7.250, P=0.009), duration of hypertension (OR=1.130, 95% CI: 1.045– 1.222, P=0.002), and low-density lipoprotein (OR=2.147, 95% CI: 1.250– 3.688, P=0.006). The discrimination with area under the curve (AUC) was 0.847 (95% CI: 0.789– 0.905) in the training set and was a slight increase to 0.907 (95% CI: 0.838– 0.976) in the validation set. The calibration curve showed high coherence between the predicted and actual probability of lacunar infarction. Moreover, the DCA analysis indicated that the nomogram had a higher overall net benefit of the threshold probability range in both two sets.Conclusion: Age, diabetes mellitus, atrial fibrillation, duration of hypertension, and low-density lipoprotein were significant predictors of lacunar infarction in hypertensive patients. The nomogram based on the clinical data was constructed, which was a useful visualized tool for clinicians to assess the risk of the lacunar infarction in hypertensive patients.Keywords: lacunar infarction, nomogram, hypertension, lasso regression, predictive model

Commonly plaguing in the frigid zone of the world, vitamin D deficiency, as indicated by low levels of 25-hydroxyvitamin D, exacerbated inflammatory responses and impaired endothelial function. Leukoaraiosis (LA) is a prevalent cause of cognitive dysfunction in the elderly and is potentially associated with inflammatory responses. This study aimed to investigate the impact of vitamin D on the severity of LA.

The lenticulostriate artery (LSA) is a vital perforating cerebral artery, whose occlusion often leads to lacunar infarction. Currently, digital subtraction angiography is mainly used to visualize the LSA in the clinical setting; however, its invasiveness is an important limiting factor. Studies have shown that time-of-flight (TOF) sequencing using a high-field magnetic resonance system (7 T) can better image the LSA. However, the diameter of the LSA is extremely small (approximately 0.3–0.7 mm) with relatively slow blood flow velocity; therefore, imaging the LSA with a 3-T magnetic resonance imaging (MRI) scanner remains challenging. This study aimed to visualize the LSA using 3-dimensional-TOF magnetic resonance angiography (MRA) with compressed sensing using a 3-T system and compare the length and number of the LSAs between patients with infarction and normal controls. The scan times of 3D-TOF MRA with and without compressed sensing were 7 min, and 8 min 44 s, respectively. VR displayed the LSA clearly under both conditions. The total number (p > 0.05) and length (p > 0.05) of the LSAs did not differ significantly between 3D-TOF MRA with and without compressed sensing. However, the total length and number of visualized LSAs was significantly lower (p < 0.05) in the infarction group compared to the control group for both TOF MRA and TOF MRA with compressed sensing. TOF MRA combined with compressed sensing is clinically valuable for analyzing the morphological characteristics of the LSA, and shortens the imaging time to 7 min. This combined technique can meet the requirements of shorter scanning times in clinical settings. [ABSTRACT FROM AUTHOR]

Abstract Objectives This study aimed to assess the epidemiological features and explore the potential risk factors for early neurological deterioration (END) in patients with acute single small subcortical infarction (SSSI) who underwent antiplatelet therapy without carotid artery stenosis. Materials & methods Patients with SSSI, as confirmed by cranial magnetic resonance imaging (MRI), who were hospitalized within 48 h after the onset of symptoms were enrolled. END was mainly defined as increment in the National Institutes of Health Stroke Scale (NIHSS) score of ≥ 2 points or any new neurological deficit. Poor functional outcome was defined as modified Rankin Scale (mRS) score of > 2 points at 3-month after the onset. The association of END with multiple indicators was assessed at the early stage of admission using multivariate logistic regression analysis, and adjusted odds ratios (aORs) were calculated. Results A total of 280 patients were enrolled from June 2020 to May 2021, of whom, END occurred in 44 (15.7%) patients (median age, 64 years; 70.5% male), while END occurred during sleep in 28 (63.6%) patients. History of hypertension (aOR: 4.82, p = 0.001), infarction in internal capsule (aOR: 3.35, p = 0.001), and elevated level of low-density lipoprotein cholesterol (LDL-C; aOR: 0.036, p = 0.0016) were significantly associated with the risk of END. Patients with END (aOR: 5.74, p = 0.002), history of diabetes (aOR: 2.61, p = 0.020), and higher NIHSS scores at discharge (per 1-score increase, aOR: 1.29, p = 0.026) were associated with the poor functional outcome at 3-month after the onset. Conclusion Patients with a history of hypertension, infarction in internal capsule or a higher level of LDL-C were found to be at a higher risk of END.

Lingjie Wang,&ast; Jun Ke,&ast; Xiaoyin Hu, Mo Zhu, Yixing Yu Department of Radiology, The First Affiliated Hospital of Soochow University, Soochow, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Mo Zhu; Yixing Yu, Department of Radiology, The First Affiliated Hospital of Soochow University, No. 188 Shizi Road, Soochow, 215000, People’s Republic of China, Tel +86-512-67973009, Fax +86-512-67973061, Email zhumo001@126.com; yuyixing@163.comPurpose: Lacunar infarction is usually diagnosed by conventional technologies, such as CT and diffusion weighted imaging (DWI). To improve the accuracy of diagnosis, neurocognitive screening is still needed. Therefore, additional imaging methods that can assist and provide more accurate and rapid diagnostics are urgently needed. As an initial step towards potentially using MR elastography (MRE) for such diagnostic purposes, we tested the hypothesis that the mechanical properties of tissue in the vicinity of cerebral vasculature change following lacunar infarction in a way that can be quantified using MRE.Patients and Methods: MRE and MR angiography (MRA) images from 51 patients diagnosed with lacunar infarction and 54 healthy volunteers were acquired on a 3T scanner. All diagnoses were confirmed by matching neurocognitive test results to locations of flow obstruction in MRA. ROIs of the cerebral vessels segmented on the MRA images were mapped to the MRE images. Interpolation-based inversion was applied to estimate the regional biomechanical properties of ROIs that included cerebral vessels. The effects of lacunar infarction, sex, and age were analyzed using analysis of covariance (ANOCOVA).Results: Shear moduli over vessel ROIs were significantly lower for the lacunar infarction group than those of the healthy control group. A positive correlation between modulus over vessel ROIs and age was observed. However, no significant correlation was found between sex and the regional biomechanical properties of the vessel ROIs.Conclusion: Results supported the hypothesis and suggest that biomechanical properties may be of utility in diagnosis of lacunar infarction.Keywords: magnetic resonance elastography, MRE, cerebral vasculature, lacunar infarction, biomechanical properties

Abstract Purpose The aim of this study is to explore the factors associated with the fall risk in type 2 diabetes (T2D) patients with a lacunar stroke. Materials and methods We compiled data of 146 T2D patients (mean age 68 years), including the Morse fall scale data (MFS), nutrition score, self-care scale, laboratory data, and data from continuous glucose monitoring system (CGMS) from 2019 to 2021 in Shanghai Pudong Hospital. Thereby, we evaluated the associations between MFS and other clinical parameters. Results The analyses showed that there were significantly increased size and numbers of lacunar infarction (p 0.05). The correlational study revealed the higher score of MFS was associated with the age (r = 0.41), number of lacunar infarction (r = 0.18), nutrition score (r = 0.20), self-care score (r = − 0.43), serum creatine level (r = 0.19), eGFR (r = − 0.26) (p

Abstract Background Available data collected from patients of different types of cerebrovascular strokes can detect risk factors, severity and clinical outcome of these patients. Differentiating between different types of strokes is mandatory for early diagnosis and proper management. The aim of this study is to compare between cerebral small vessel disease with lacunar infarctions and internal border zone infarctions regarding vasomotor reactivity by using transcranial color-coded duplex and its correlation with their MRI perfusion, disease severity and outcome. Results On admission, 56.7% of patients in lacunar stroke had impaired reactivity vs. 100% of patients in internal border zone group. At 3 months follow-up, this number dropped to 23.3% in lacunar group, but persisted as 100% in internal border zone group. On comparing the 3 perfusion parameters between the 2 groups, there was statistically significant impairment in all parameters in patients with internal border zone infarction than patients with lacunar infarction (longer time to peak, decreased cerebral blood flow and cerebral blood volume). By comparing the severity of the stroke by using National Institute of Health and Stroke Scale, it was found that patients with internal border zone infarction had higher disability than patients with lacunar infarction on admission and on discharge. At 3 months follow-up, the lacunar group had a better outcome than of the border zone group. Conclusion Patients having internal border zone infarction had higher clinical disability and worse prognosis, together with more impairment in vasomotor reactivity and MRI perfusion parameters than patients having lacunar infarction.

Objectives: This study aimed to assess the epidemiological features and explore the potential risk factors for early neurological deterioration (END) in patients with acute single small subcortical infarction (SSSI) who underwent antiplatelet therapy without carotid artery stenosis. Materials & methods: Patients with SSSI, as confirmed by cranial magnetic resonance imaging (MRI), who were hospitalized within 48 h after the onset of symptoms were enrolled. END was mainly defined as increment in the National Institutes of Health Stroke Scale (NIHSS) score of ≥ 2 points or any new neurological deficit. Poor functional outcome was defined as modified Rankin Scale (mRS) score of > 2 points at 3-month after the onset. The association of END with multiple indicators was assessed at the early stage of admission using multivariate logistic regression analysis, and adjusted odds ratios (aORs) were calculated. Results: A total of 280 patients were enrolled from June 2020 to May 2021, of whom, END occurred in 44 (15.7%) patients (median age, 64 years; 70.5% male), while END occurred during sleep in 28 (63.6%) patients. History of hypertension (aOR: 4.82, p = 0.001), infarction in internal capsule (aOR: 3.35, p = 0.001), and elevated level of low-density lipoprotein cholesterol (LDL-C; aOR: 0.036, p = 0.0016) were significantly associated with the risk of END. Patients with END (aOR: 5.74, p = 0.002), history of diabetes (aOR: 2.61, p = 0.020), and higher NIHSS scores at discharge (per 1-score increase, aOR: 1.29, p = 0.026) were associated with the poor functional outcome at 3-month after the onset. Conclusion: Patients with a history of hypertension, infarction in internal capsule or a higher level of LDL-C were found to be at a higher risk of END. [ABSTRACT FROM AUTHOR]

Introduction: Studies regarding multiple chronic lacunes (MCLs) and clinical outcome according to stroke etiology are scarce. We sought to evaluate the association between MCL and short-term/long-term clinical outcomes according to stroke etiology. Patients and methods: We analyzed a prospectively collected stroke registry of acute ischemic stroke patients over 4 years. The enrolled patients were classified as having large artery atherosclerosis (LAA), small vessel occlusion (SVO), cardioembolic (CE) stroke, and other etiology. The early neurological deterioration (END) and favorable outcome at 3 months were assessed. Results: A total of 1070 patients were enrolled. Patients with MCL had significantly more END compared to those without MCL both in total population (adjusted odds ratio (OR), 1.7; 95% confidence interval [CI], 1.1–2.5; p = 0.013*) and in the LAA group (adjusted OR, 2.3; 95% CI, 1.3–4.2, p < 0.006). Patients with MCL had a significantly lower OR for favorable outcome at 3 months compared to those without MCL both in total population (adjusted OR, 0.7; 95% CI, 0.5–1.0, p = 0.035) and in the LAA group (adjusted OR, 0.6; 95% CI, 0.3–1.0, p = 0.043). However, MCL was not associated with END or long-term functional outcome in patients with SVO, CE, or other etiology. Conclusions: The presence of MCL was an independent predictive factor for END as well as long-term poor functional outcome in acute ischemic stroke patients. These associations were only observed in patients with LAA, not in those with SVO, CE, or other etiology. [ABSTRACT FROM AUTHOR]

Background: Early neurological deterioration (END) is not a rare phenomenon in single subcortical infarction (SSI; traditionally known as lacunar infarction) patients. Predictors of END in SSI patients are uncertain. Aims: We aimed to investigate the association between infarct lesion characteristics, penetrating artery morphology, carrier artery plaque features and END using whole-brain vessel-wall imaging. Methods: We prospectively collected data from SSI patients without stenosis of the corresponding carrier artery. The infarct lesion size and location, lenticulostriate artery (LSA) morphological characteristics, and features of the middle cerebral artery (MCA) plaques involving M1 segment adjacent to LSA origin on the symptomatic side were compared between patients with or without END. Results: A total of 74 participants were enrolled, of whom 23 cases (31.1%) showed END. Multivariable logistic regression analysis adjusted for baseline National Institutes of Health Stroke Scale score and axial maximal diameter of infarct lesion revealed that the patients with MCA plaques adjacent to the LSA origin were more likely to develop END (odds ratio (OR) = 3.87, 95% confidence interval (CI) = 1.21–12.33), while with longer average length of LSAs were less likely to occur END (OR = 0.21, 95% CI = 0.05–0.92). Conclusion: MCA plaques located adjacent to the LSA origin and average length of LSAs on the symptomatic side were independent predictors of END in SSI patients. This finding might provide new insights into the mechanisms of the neurological progression in SSI and facilitate therapeutic interventions. [ABSTRACT FROM AUTHOR]

Cerebral white matter lesion (WML) and lacunar infarction (LI) were primary causes of cognitive deficit. Our study aimed to investigate the correlation between LI and cognitive deficit in the elderly with WML. A total of 118 participants (96 WML patients and 22 controls) were consecutively enrolled according to neuroimaging diagnosis of magnetic resonance imaging for this retrospective study. Neuroimaging evaluation and cognitive function assessment were analyzed. Compared with the controls, moderate and severe WML groups had significantly lower scores of Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment (MOCA). Most cognitive domains of MOCA scores decreased, corresponding to the severity of WMLs. While there was no significant difference in score of MMSE between deep WML (DWML) and periventricular WML (PVL) groups, the scores of visuospatial/executive and naming function domains of MOCA appeared to be low in the DWML group. The scores of MMSE and MOCA were higher in only WMLs (WML−) group than WMLs combined with LIs (WML+) group, except for the naming cognitive domain. Moreover, LIs were independently correlated with the cognitive deficit in the elderly with WMLs. In the elderly with WMLs, the presence of LIs is associated with further aggravation of cognitive deficit.

An increased number of cerebral microbleeds (CMBs) is considered a predictive factor for recurrent small vessel cerebrovascular diseases, including lacunar infarction and non-lobar intracerebral hemorrhage (ICH). However, it is unclear which recurrent stroke pattern is mainly reflected in the number of CMBs. This study enrolled 217 patients with their first stroke (148 deep lacunar infarctions and 69 non-lobar ICHs), between January 2009 and March 2015. The numbers of baseline and newly appearing CMBs in patients with recurrent stroke were compared with those in patients with non-recurrent stroke, and the dynamics of the number of CMBs was evaluated according to recurrent stroke patterns. Fifty-nine patients with recurrent stroke were included in this study. A larger number of baseline and newly appearing CMBs was significantly associated with recurrent stroke (p = 0.04, p < 0.001, respectively). Recurrent stroke patterns were divided into four types: deep lacunar infarction/deep lacunar infarction (37 patients), deep lacunar infarction/non-lobar ICH (eight patients), non-lobar ICH/deep lacunar infarction (eight patients), and non-lobar ICH/non-lobar ICH (six patients). The number of newly appearing CMBs was significantly higher in patients with deep lacunar infarction/non-lobar ICH than in those with other recurrent stroke patterns (p = 0.04). The number of CMBs is associated with recurrent stroke, including deep lacunar infarction and non-lobar ICH, and differs depending on the recurrent stroke patterns. The increase in the number of CMBs was strongly correlated with the deep lacunar infarction/non-lobar ICH recurrence pattern. [ABSTRACT FROM AUTHOR]

Lacunar infarction (LI) is a common and heterogeneous subtype of ischemic stroke, which in 3/4 cases occurs on the background of already existing subclinical manifestations of cerebral small vessel disease (SVD), which contributes to the development of recurrent LI. Dysfunction of the vascular endothelium and the blood-brain barrier (BBB) is considered to be the main pathogenetic mechanisms of the formation of LII and SVD, which develops a result of vascular risk factors action and acute or chronic ctrebtal ischemia and is manifested by impaired autoregulation of small cerebral vessels, dysfunction of the neurovascular interface in the neurovascular unit, leading to a decrease in the level of cerebral blood flow, hypoperfusion of the white matter of the brain, an increase in the permeability of the BBB. There are several potential atherosclerotic mechanisms that can lead to LI - atheromatous disease in the region of a branch of small arteries and atherosclerotic plaques of the maternal artery, which can involve the orifice of perforating branches with their occlusion, associated with g atherosclerosis of intracranial arteries. Adequate reperfusion and early antithrombotic therapy, control of risk factors for recurrent LI, the main of which is arterial hypertension, are considered a critical element of effective secondary prevention of not only lacunar stroke (LI), but also vascular dementia, vascular parkinsonism, and vascular depression. [ABSTRACT FROM AUTHOR]

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Background: Available data collected from patients of different types of cerebrovascular strokes can detect risk factors, severity and clinical outcome of these patients. Differentiating between different types of strokes is mandatory for early diagnosis and proper management. The aim of this study is to compare between cerebral small vessel disease with lacunar infarctions and internal border zone infarctions regarding vasomotor reactivity by using transcranial color-coded duplex and its correlation with their MRI perfusion, disease severity and outcome. Results: On admission, 56.7% of patients in lacunar stroke had impaired reactivity vs. 100% of patients in internal border zone group. At 3 months follow-up, this number dropped to 23.3% in lacunar group, but persisted as 100% in internal border zone group. On comparing the 3 perfusion parameters between the 2 groups, there was statistically significant impairment in all parameters in patients with internal border zone infarction than patients with lacunar infarction (longer time to peak, decreased cerebral blood flow and cerebral blood volume). By comparing the severity of the stroke by using National Institute of Health and Stroke Scale, it was found that patients with internal border zone infarction had higher disability than patients with lacunar infarction on admission and on discharge. At 3 months follow-up, the lacunar group had a better outcome than of the border zone group. Conclusion: Patients having internal border zone infarction had higher clinical disability and worse prognosis, together with more impairment in vasomotor reactivity and MRI perfusion parameters than patients having lacunar infarction. [ABSTRACT FROM AUTHOR]

Background: Post-stroke cognitive impairment (PSCI) after lacunar infarction was worth attention in recent years. An easy-to-use score model to predict the risk of PSCI was rare. This study aimed to explore the association between serum amyloid A (SAA) and cognitive impairment, and it also developed a nomogram for predicting the risk of PSCI in lacunar infarction patients. Methods: A total of 313 patients with lacunar infarction were enrolled in this retrospective study between January 2021 and December 2021. They were divided into a training set and a validation set at 70%:30% randomly. The Chinese version of the Mini-Mental State Examination (MMSE) was performed to identify cognitive impairment 3 months after discharge. Univariate and multivariate logistic regression analyses were used to determine the independent risk factors for PSCI in the training set. A nomogram was developed based on the five variables, and the calibration curve and the receiver operating characteristic (ROC) curve were drawn to assess the predictive ability of the nomogram between the training set and the validation set. The decision curve analysis (DCA) was also conducted in both sets. Results: In total, 52/313 (16.61%) participants were identified with PSCI. The SAA levels in patients with PSCI were significantly higher than non-PSCI patients in the training set (P < 0.001). After multivariate analysis, age, diabetes mellitus, white blood count, cystatin C, and SAA were independent risk predictors of PSCI. The nomogram demonstrated a good discrimination performance between the training set (AUC = 0.860) and the validation set (AUC = 0.811). The DCA showed that the nomogram had a well clinical utility in the two sets. Conclusion: The increased SAA is associated with PSCI in lacunar infarction patients, and the nomogram developed with SAA can increase prognostic information for the early detection of PSCI. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to explore the factors associated with the fall risk in type 2 diabetes (T2D) patients with a lacunar stroke. Materials and methods: We compiled data of 146 T2D patients (mean age 68 years), including the Morse fall scale data (MFS), nutrition score, self-care scale, laboratory data, and data from continuous glucose monitoring system (CGMS) from 2019 to 2021 in Shanghai Pudong Hospital. Thereby, we evaluated the associations between MFS and other clinical parameters. Results: The analyses showed that there were significantly increased size and numbers of lacunar infarction (p < 0.05). Furthermore, the greater risk group had an older mean age (p < 0.05), and significant decreased estimated glomerular filtration rate (eGFR), total triglyceride (TG), while increased microalbuminuria, magnesium, lipoprotein A (LP(a)), anti-thyroid peroxidase antibody (TPOAb) (p < 0.05). However, the time in range (TIR) was very comparable (p > 0.05). The correlational study revealed the higher score of MFS was associated with the age (r = 0.41), number of lacunar infarction (r = 0.18), nutrition score (r = 0.20), self-care score (r = − 0.43), serum creatine level (r = 0.19), eGFR (r = − 0.26) (p < 0.05). The total numbers of lacunar infarction were associated with age (r = 0.36), eGFR (r = − 0.40), homocysteine level (r = 0.33) (p < 0.05). Conclusions: Age, nutrition, self-care ability, and renal function are all critical factors associated with the risk of fall in T2D with lacunar infarction. The age, eGFR, and homocysteine are closely associated with lacunar infarction, suggesting that in T2D, evaluation of kidney dysfunction, homocysteine level in the elderly can predict lacunar infarcts and falls. [ABSTRACT FROM AUTHOR]

Cerebral small vessel disease (CSVD) is a common cerebrovascular disease and an important cause of gait and balance disorders. Gait and balance disorders can further lead to an increased risk of falls and a decreased quality of life. CSVD can damage gait and balance function by affecting cognitive function or directly disrupting motor pathways, and different CSVD imaging features have different characteristics of gait and balance impairment. In this article, the correlation between different imaging features of sporadic CSVD and gait and balance disorders has been reviewed as follows, which can provide beneficial help for standardized management of CSVD. [ABSTRACT FROM AUTHOR]

Focal neurological deficit like monoparesis due to cortical lesions is a rare entity. In spite of the common presentations like seizures and headaches in neurocysticercosis, occurrence of reversible monoparesis is an atypical phenomenon. Even in the absence of infarct or hemorrhages, manifestation of neural deficit due to compressive effect only is an interesting finding. And on top of that, reversible nature of the deficit in space occupying lesion is a rare occurrence in the existing literature. Here, we describe a known case of neurocysticercosis with reversible acute monoparesis secondary to multiple neurocysticercosis. The variations with which neurocysticercosis can present broaden our understanding in its pathophysiology and management protocol. [ABSTRACT FROM AUTHOR]

• With differences between SVD and LVD, the prevalences of SVDs were associated with severe CA stenoses. • SVD includes white matter lesions, LI and CMBs, however CMBs were not associated with severe CA stenoses. • Hyperlipidemia related to atherosclerosis might reduce the prevalence of deep CMBs and mixed CMBs. Small vessel diseases (SVDs) are often asymptomatic. However, SVDs significantly influence the prognosis in patients with large vessel diseases (LVDs). We investigated asymptomatic cerebral findings on 3-Tesla MRI in patients with severe carotid artery (CA) stenoses, compared to peoples without a past history of neurological disorders, including strokes. We retrospectively analyzed the prevalences of various asymptomatic cerebral findings which were intracerebral hemorrhages (ICHs), cortical superficial siderosis, ventricular dilatation (Evans' index) and SVDs including cerebral microbleeds (CMBs), lacunar infarctions (LIs), deep white matter hyperintensities (WMHs), periventricular hyperintensities (PVHs). The prevalence of each finding was compared using multivariate logistic regression models with adjustment for stroke risk factors. We evaluated the findings in 54 patients with severe CA stenosis treated by stenting (CA stenosis group) and 200 adults with health screening tests of the brain and no past history of neurological disorders (control group). Multivariate analyses adjusted for age ≥ 65 years old, female gender, hypertension, hyperlipidemia, diabetes mellitus, alcohol consumption, and smoking index revealed that the prevalences of severe PVHs, severe deep WMHs, asymptomatic deep ICHs, and asymptomatic LIs were significantly higher in the CA stenosis group than the control group. However, there were no significant differences in the prevalences of CMBs, or the remaining asymptomatic findings described above. With pathological differences between SVD and LVD, asymptomatic SVDs except CMBs and deep ICHs often co-exists severe CA stenosis as a presentative LVD. [ABSTRACT FROM AUTHOR]

Moyamoya is a rare occlusive cerebrovascular disease characterized by progressive stenosis of the terminal portion of the internal carotid artery and the circle of Willis. Over time, collateral arteries are usually formed at the basal ganglia, the so-called Moyamoya vessels. The exact cause of Moyamoya disease is unknown, while Moyamoya syndrome refers to Moyamoya-like vasculopathy due to autoimmune diseases, neurofibromatosis type I, sickle cell disease, radiation, or rarely Down syndrome. Down syndrome is one of the most common genetic conditions, characterized by typical physical traits, associated with intellectual disability and a heterogeneous group of structural defects that may vulnerable the patient for the development of Moyamoya syndrome. The reported case is an unusual case of a 2-year-old boy with Down syndrome who presented to the hospital with seizures and right-side weakness. Brain MRI shows acute as well as old lacunar infarctions in both cerebral hemispheres. Catheter angiography of the patient demonstrates severe stenosis and occlusion of the large vessels of the circle of Willis, predominantly on the right side. The collateral vessels with the typical pattern of “puff of smoke” were also depicted in the right basal ganglia, which is a characteristic imaging finding for Moyamoya. The patient was managed conservatively and eventually discharged with a minimal improvement of the right-sided weakness. This case report is noteworthy because of the rarity of Moyamoya syndrome as a cause of a stroke as well as its possible association with Down syndrome.

Abstract Focal neurological deficit like monoparesis due to cortical lesions is a rare entity. In spite of the common presentations like seizures and headaches in neurocysticercosis, occurrence of reversible monoparesis is an atypical phenomenon. Even in the absence of infarct or hemorrhages, manifestation of neural deficit due to compressive effect only is an interesting finding. And on top of that, reversible nature of the deficit in space occupying lesion is a rare occurrence in the existing literature. Here, we describe a known case of neurocysticercosis with reversible acute monoparesis secondary to multiple neurocysticercosis. The variations with which neurocysticercosis can present broaden our understanding in its pathophysiology and management protocol.

Jia Yang,1 Zhandong Qiu,1,2 Yu Fang3 1Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing 100053, People’s Republic of China; 2Department of Neurology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People’s Republic of China; 3Department of Emergency Medicine, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People’s Republic of ChinaCorrespondence: Zhandong Qiu Email 003qiu86@163.comObjective: To compare the differences in neuropsychological and personality characteristics between male patients with lacunar infarction with hazardous drinking and non-hazardous drinking.Methods: From May to October 2016, a total of 124 male outpatients and inpatients with lacunar infarction were selected in the Department of Neurology, Tongji Hospital, and they were divided into a hazardous drinking group (HD group, n=52) and a non-hazardous drinking group (NHD group, n=72) according to alcohol consumption habits. General information, MoCA score, EPQ score and SCL-90 score were compared between the two groups.Results: Incidence of cognitive disorder in the HD group and NHD group was 59.6% and 56.9% respectively, showing no significant difference (P> 0.05). Scores of visuospatial and executive function, memory, attention and total MoCA score in the HD group were significantly lower than those in the NHD group (P< 0.05), while no significant difference in naming, language, abstract thinking or orientation was found between the two groups (P> 0.05). Scores of extroversion and introversion, neuroticism and psychoticism in the HD group were significantly higher than those in the NHD group (P< 0.05), while no significant difference in lie or feint score was found between the two groups (P> 0.05). Scores of somatization, interpersonal sensitivity, anxiety, hostility, bigotry and psychoticism factors, and total SCL-90 score in the HD group were significantly higher than those in the NHD group (P< 0.05), while no significant difference in scores of obsessive-compulsive, depression and terror factors were found between the two groups (P> 0.05).Conclusion: Compared with male patients with lacunar infarction with non-hazardous drinking, male lacunar infarction patients with hazardous drinking showed worse visuospatial and executive function, memory, attentiveness, cognitive function and mental health status, with more obvious change of personality, thus extra attention is needed for male lacunar infarction patients with hazardous drinking.Keywords: male, lacunar infarction, hazardous drinking, neuropsychology, personality

Objective: The correct and rapid classification of the ischemic stroke subtype enables the determination of the proper treatment and a better prognosis. In this study, we investigated the association of ischemic stroke subtypes with early diffusion-weighted magnetic resonance imaging (MRI) lesion patterns. Materials and Methods: Three hundred forty-three consecutive patients with acute ischemic stroke were retrospectively evaluated. The ischemic stroke subtype for each patient was determined according to “Trial of Org 10172 in Acute Stroke Treatment Classification”. The lesion patterns in diffusion-weighted MRI in the first 24 hours of stroke were classified as single lesions, diffuse scattered lesions limited to one vascular area, and multiple territory lesions. The relationship between the diffusion-weighted MRI lesion patterns and ischemic stroke subtypes was investigated using the chi-square test. Results: The diffusion-weighted MRI lesion patterns showed significant differences among the ischemic stroke subtypes. Multiple territory lesions were more frequent in the cardioembolic and other determined causes groups compared with the large artery atherosclerosis group. Diffuse scattered lesions limited to one vascular area were more frequent in the large artery atherosclerosis, the unknown cause and the other determined causes groups than the others (p

AIM: To investigate the correlation of ischemic ophthalmopathy (IO) with lacunar infarction (LI), an ischemic lesions in the cerebrovascular system. METHODS: Totally 204 cases of IO without any nervous system symptom and previously diagnosed LI served as the observational group. All 204 cases without IO, nervous system symptoms and previous LI served as the control group. Age and sex between the two groups matched well. LI was diagnosed by magnetic resonance imaging (MRI) and the results of the two groups were statistically analyzed and compared. RESULTS: IO included 174 eyes of 156 patients with non-arteritis anterior ischemic optic neuropathy (NAION), 42 eyes of 36 patients with central retinal artery occlusion (CRAO) or branch retinal artery occlusion (BRAO) and 12 eyes of 12 patients with ocular ischemia syndrome (OIS).The detection rate of LI (72.54%) in IO group was obviously higher than that (15.68%) in the control group (P

We hypothesized that the current criteria may be unsuitable for lacunar pontine infarctions (LPI) diagnosis and that size criteria may indicate different stroke mechanisms.

Background: Branch atheromatous disease (BAD) is a form of ischemic stroke that presents with imaging findings similar to those of lacunar infarction, but has a different pathogenesis and is known to cause progressive paralysis. Due to regional variations, the epidemiology of BAD is not wellunderstood, and its relationship with functional prognosis remains unclear. Using a comprehensive Japanese stroke database, we investigated its epidemiological characteristics and associations with functional outcomes., Methods: In this multicenter cohort study, we retrospectively analyzed data from the Saiseikai Stroke Database (2013-2021) including 27 hospitals. We used multivariable logistic regression to calculate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) of BAD compared with LI for functional outcomes at discharge. Ischemic stroke caused by BAD or LI was included and demographic characteristics and clinical data were evaluated and contrasted between BAD and LI., Results: Of the 5,966 analyzed patients, 1,549 (25.9%) had BAD and 4,434 (74.1%) had LI. BAD was associated with worse functional outcomes (adjusted OR of 2.77, 95%CI: 2.42-3.17, relative to LI) and extended hospital stays (median 19 days for BAD vs. 13 days for LI). Moreover, aggressive treatment strategies, including the use of argatroban and dual antiplatelet therapy, were more common in BAD patients., Conclusions: BAD presented worse functional outcomes and longer hospital stays than LI, necessitating treatment plans that take into account its progression and prognosis.

Abstract Objectives A retrospective study was performed to investigate the relationship between blood pressure variability (BPV) and imaging features of single small infarction (SSI) on magnetic resonance imaging (MRI). Materials and Methods Two hundreds and five patients with SSI and 120 healthy subjects matched with age and sex as the control group were enrolled into this study. All subjects came from the Affiliated Hospital to Qingdao University and Qingdao Municipal Hospital from October 2011 to June 2016. Research subjects were classified into different groups. Blood pressure was measured once a day and recorded during the hospitalization period (7–10 days). The followed up data of patients after discharging from hospital was collected from the follow‐up records. Results Twenty‐four hours BPV (SBPMean, DSBPMax, DSBPSD, NDBPMax, NDBPSD, and DDBPCV), day‐to‐day, and visit‐to‐visit BPV (SBPMax, SBPSD, DBPMax, and DBPSD) in the SSI group were significantly higher than that in control group. Compared with the giant lacunar group, day‐to‐day BPV (SBPMean, SBPMax, SBPSD, SBPCV, DBPMean, DBPMax, DBPSD), and visit‐to‐visit BPV (SBPMean, SBPMax, SBPSD, DBPMean, DBPMax, DBPSD) were significantly higher in the small lacunar infarct group (p

BACKGROUND: The lacunar dysarthria-clumsy hand syndrome was described by Miller-Fisher in 1967. Although other pathophysiological mechanisms, such as atherothrombotic or embolic infarction have been described, the lacunar hypothesis originally described by Miller-Fisher remains as the main mechanism in this syndrome. CLINICAL CASE: A 59-year-old female patient with history of hypertension who suddenly developed dysarthria-clumsy hand syndrome as a result of a lacunar infarction in the left internal capsule, secondary to a hypertensive emergency. After management of blood pressure, neurologic symptoms disappeared, with an excellent prognosis in short and medium term. CONCLUSIONS: Compared to other ischemic strokes, a more favorable prognosis has been described in lacunar strokes. In those presenting as dysarthria-clumsy hand syndrome mortality is very low with excellent prognosis. [ABSTRACT FROM AUTHOR]

Objectives: A retrospective study was performed to investigate the relationship between blood pressure variability (BPV) and imaging features of single small infarction (SSI) on magnetic resonance imaging (MRI). Materials and Methods: Two hundreds and five patients with SSI and 120 healthy subjects matched with age and sex as the control group were enrolled into this study. All subjects came from the Affiliated Hospital to Qingdao University and Qingdao Municipal Hospital from October 2011 to June 2016. Research subjects were classified into different groups. Blood pressure was measured once a day and recorded during the hospitalization period (7–10 days). The followed up data of patients after discharging from hospital was collected from the follow‐up records. Results: Twenty‐four hours BPV (SBPMean, DSBPMax, DSBPSD, NDBPMax, NDBPSD, and DDBPCV), day‐to‐day, and visit‐to‐visit BPV (SBPMax, SBPSD, DBPMax, and DBPSD) in the SSI group were significantly higher than that in control group. Compared with the giant lacunar group, day‐to‐day BPV (SBPMean, SBPMax, SBPSD, SBPCV, DBPMean, DBPMax, DBPSD), and visit‐to‐visit BPV (SBPMean, SBPMax, SBPSD, DBPMean, DBPMax, DBPSD) were significantly higher in the small lacunar infarct group (p <.05). The 24 hr BPV (SBPMean, DDBPMax, DDBPMean), day‐to‐day BPV (SBPMax, SBPSD, SBPCV), and visit‐to‐visit SBPMax in nonround lesion group were significantly higher than that in round group (p <.05). Compared with nondeep lesion group, some parameters in day‐to‐day BPV and visit‐to‐visit BPV were significantly higher in the deep small lesion group (p <.05). Conclusion: Increased BPV parameters such as day‐to‐day and visit‐to‐visit (SBPMax, SBPSD, DBPMax) were related to the SSI characterized by small lesion in deep brain region. [ABSTRACT FROM AUTHOR]

Intravenous recombinant tissue plasminogen activator (iv-rtPA) has been routinely used to treat ischemic stroke for 25 years, following large clinical trials. However, there are few prospective studies on the efficacy and safety of this therapy in strokes attributed to cerebral small vessel disease (SVD). We evaluated functional outcome (modified Rankin scale, mRS) and symptomatic intracerebral hemorrhage (sICH) using all available data on the effects of iv-rtPA in SVD-related ischemic stroke (defined either using neuroimaging, clinical features, or both). Using fixed-effect and random-effects models, we calculated the pooled effect estimates with regard to excellent and favorable outcomes (mRS=0–1 and 0–2 respectively, at 3 months), and the rate of sICH. Twenty-three studies fulfilled the eligibility criteria, 11 of which were comparative, and there were only 3 randomized clinical trials. In adjusted analyses, there was an increased odds of excellent outcome (adjusted OR=1.53, 95% CI: 1.29–1.82, I2: 0%) or favorable outcome (adjusted OR=1.68, 95% CI: 1.31–2.15,I2: 0%) in patients who received iv-rtPA compared with placebo. Across the six studies which reported it, the incidence of sICH was higher in the treatment group (M-H RR = 8.83, 95% CI: 2.76–28.27). The pooled rate of sICH in patients with SVD administered iv-rtPA was only 0.72% (95% CI: 0.12%–1.64%). We conclude that when ischemic stroke attributed to SVD is considered separately, available data on the effects of iv-rtPA therapy are insufficient for the highest level of recommendation, but it seems to be safe. Although further therapeutic trials in SVD-related ischemic stroke appear to be justified, our findings should not prevent its continued use for this group of patients in clinical practice. [ABSTRACT FROM AUTHOR]

Objective:To investigate, in basal ganglia, the factors associated with early neurological deterioration (END) of isolated acute lacunar infarction.Methods:167 patients, in the retrospective group, with isolated acute lacunar infarction in basal ganglia, were defined by magnetic resonance imaging (MRI). The National Institutes of Health Stroke Scale (NIHSS) defined early neurological deterioration as increases of ≥ 2 within 72 hours following admission. Baseline variables predicting END were investigated with multivariate logistic regression analysis.Results:In the study, END occurred in 42 (25.15%) patients. Lesions located in posterior limb of internal capsule were independent risk factors for END (P P P Conclusions:There is a close relationship between the lesion location and other related factors, such as lesions of cerebral white matter, history of cerebral infarction, history of diabetes and age, etc. and END in patients with isolated acute lacunar infarction in basal ganglia. Protective factors of END included age ≥ 65, high systolic pressure, stroke history, cerebral white matter lesions in our study.

目的 探讨腔隙性脑梗死（lacunar infarction，LI）认知功能障碍与颈动脉粥样硬化性斑块的关系。 方法 回顾性分析2017年1月-2018年11月就诊于海淀医院神经内科的符合LI诊断标准的患者171例，按照蒙特利尔认知评估量表（Montreal cognitive assessment scale，MoCA）评分分为认知功能障碍组和非认知功能障碍组，对颈动脉动脉粥样硬化性斑块与认知功能障碍之间的关系进行Logistic多因素回归分析。 结果 调整潜在混杂因素后，颈动脉动脉粥样硬化性斑块数≥2对LI患者合并认知功能障碍有独立影响（OR 2.843，95%CI 1.301～6.216，P=0.008）。有动脉粥样硬化性斑块颈动脉数≥2也是LI患者合并认知功能障碍的独立影响因素（OR 2.899，95％CI 1.311～6.409，P=0.008）。 结论 颈动脉动脉粥样硬化性斑块数、有动脉粥样硬化性斑块的颈动脉数增加，LI患者合并认知功能障碍的风险也增加。 Objective To investigate the relationship between cognitive impairment in lacunar infarction (LI) and carotid atherosclerotic plaque. Methods A retrospective analysis of 171 patients who met the LI diagnostic criteria in the Department of Neurology, Haidian Hospital from January 2017 to November 2018, and had baseline MoCA scores, were divided into cognitive impairment group and non-cognitive impairment group. Carotid ultrasonography were performed in all patients to observe carotid plaques. Multivariate Logistic regression was used to analyze the relationship between carotid atherosclerotic plaque and cognitive impairment. Results After adjusting for potential confounders, the incidence of cognitive impairment was higher in patients with ≥2 carotid atherosclerotic plaques compared with patients without carotid atherosclerotic plaque (OR 2.843, 95%CI 1.301-6.216, P=0.008). Patients with ≥2 carotid arteries with atherosclerotic plaque had a higher incidence of cognitive impairment (OR 2.899, 95%CI 1.311-6.409, P=0.008). Conclusions The number of carotid atherosclerotic plaque is an independent risk factor of cognitive impairment in LI patients. With the number of atherosclerotic plaques increasing, the risk of cognitive impairment may increase. The number of carotid artery with atherosclerotic plaque is also an independent risk factor of cognitive impairment in LI patients. With the number of carotid artery with atherosclerotic plaque increasing, the risk of cognitive impairment may increase.

Introduction: Cerebral small vessel disease (CSVD), a common finding in patients with vas-cular risk factors, is associated with motor, cognitive and affective disorders. Magnetic resonance imaging (MRI) brain scans of patients with CSVD include lacunar infarcts and/or white matter hyperintensities (WMH) and microhemorrhages. Aside from rare familiar forms of CSVD, patients with headaches, especially migraineurs, have an increased risk to develop these lesions, although this relationship is rather complex and yet to be fully elucidated. Aim: The aim of the study was to determine the frequency and type of headache in patients with CSVD. Material and methods: This retrospective study included 115 patients with CSVD diagnosis admitted at the Clinic of Neurology, Clinical Center of Serbia in the period January 1 st , 2015-December 31 st , 2017. Baseline demographic data, headache type and MRI findings (ischemic lacunar infarctions, WMH, and overall lesion severity) were obtained. Data were compared between CSVD patients with headache and headache-free CSVD cases, with the use of standard statistical methods. Results: Among all patients included in this study, 44% had headaches. Lacunar infarcts were present in 86,1% and WMH in 46,1% cases. Correlation between headache symptoms and lacunar infarcts showed a trend towards statistical significance (p = 0.072) whereas headache free patients more frequently had WMH, also approaching statistical significance (p = 0.065). Conclusion: A large number of arteriolosclerotic CSVD patients complain of different types of headaches. Based on MRI findings, lacunar infarcts are related to headache symptoms, and WMHs are more frequently present in patients with a negative history of headache.

Ling Yu,1 Lei Yang,2 Xiaoyu Zhang,2 Junliang Yuan,2 Yue Li,2 Shuna Yang,2 Hua Gu,2 Wenli Hu,2 Shan Gao1 1Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China Background and purpose: White matter hyperintensities (WMH) is identified as a marker of cerebral small vessel diseases and is a major contributor to cognitive impairment, depression, gait disturbance, and urinary incontinence. However, the risk factors for WMH in patients with type 2 diabetes mellitus (T2DM) has not been well explored. Thus, in this study, we aimed to investigate the relationship between the severity of WMH and vascular risk factors in lacunar infarction patients with T2DM. Methods: Consecutive lacunar infarction patients with T2DM were recruited in this cross-sectional study. Paraventricular WMH (P-WMH) and deep WMH (D-WMH) were separately scored by the Fazekas scale, and classified into two categories by the severity. Vascular risk factors and clinical features were compared between the mild and severe WMH. Multiple logistic regression analysis was used to determine the relationship between severity of WMH and vascular risk factors. Results: A total of 327 participants aged 34–91 years were enrolled in this study. Compared with the patients with mild P-WMH, the patients with severe P-WMH had higher age (P=0.031), higher proportion of hypertension (P=0.042) and stroke (P

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Background and purpose: This was an investigation of the differential effects of early intensive versus guideline‐recommended blood pressure (BP) lowering between lacunar and non‐lacunar acute ischaemic stroke (AIS) in the BP arm of the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). Methods: In 1,632 participants classified as having definite or probable lacunar (n = 454 [27.8%]) or non‐lacunar AIS according to pre‐specified definitions based upon clinical and adjudicated imaging findings, mean BP changes over days 0–7 were plotted, and systolic BP differences by treatment between subgroups were estimated in generalized linear models. Logistic regression models were used to estimate the BP treatment effects on 90‐day outcomes (primary, an ordinal shift of modified Rankin scale scores) across lacunar and non‐lacunar AIS after adjustment for baseline covariables. Results: Most baseline characteristics, acute BP and other management differed between lacunar and non‐lacunar AIS, but mean systolic BP differences by treatment were comparable at each time point (all pinteraction > 0.12) and over 24 h post‐randomization (−5.5, 95% CI −6.5, −4.4 mmHg in lacunar AIS vs. −5.6, 95% CI −6.3, −4.8 mmHg in non‐lacunar AIS, pinteraction = 0.93). The neutral effect of intensive BP lowering on functional outcome and the beneficial effect on intracranial haemorrhage were similar for the two subgroups (all pinteraction > 0.19). Conclusions: There were no differences in the treatment effect of early intensive versus guideline‐recommended BP lowering across lacunar and non‐lacunar AIS. [ABSTRACT FROM AUTHOR]

Increasing evidence suggests that features of the gut microbiota correlate with ischemic stroke. However, the specific characteristics of the gut microbiota in patients suffering different types of ischemic stroke, or recovering from such strokes, have rarely been studied, and potential microbiotic predictors of different types of stroke have seldom been analyzed. We subjected fecal specimens from patients with lacunar or non-lacunar acute ischemic infarctions, and those recovering from such strokes, to bacterial 16S rRNA sequencing and compared the results to those of healthy volunteers. We identified microbial markers of different types of ischemic stroke and verified that these were of diagnostic utility. Patients with two types of ischemic stroke, and those recovering from ischemic stroke, exhibited significant shifts in microbiotic diversities compared to healthy subjects. Cluster of Orthologous Groups of Proteins (COG) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses revealed reduced metabolic and transport-related pathway activities in ischemic stroke patients. We performed fivefold cross-validation using a Random Forest model to identify two optimal bacterial species (operational taxonomic units; OTUs) serving as markers of lacunar infarction; these were Lachnospiraceae (OTU_45) and Bacteroides (OTU_4), and the areas under the receiver operating characteristic curves (AUCs under the ROCs) were 0.881 and 0.872 respectively. In terms of non-lacunar acute ischemic infarction detection, the two optimal species were Bilophila (OTU_330) and Lachnospiraceae (OTU_338); the AUCs under the ROCs were 0.985 and 0.929 respectively. In post-ischemic stroke patients, the three optimal species were Pseudomonas (OTU_35), Sphingomonadaceae (OTU_303), and Akkermansia (OTU_9); the AUCs under the ROCs were 1, 0.897, and 0.846 respectively. Notably, the gut microbial markers were of considerable value for utility when diagnosing lacunar infarction, non-lacunar acute ischemic infarction, and post-ischemic stroke. This study is the first to characterize the gut microbiotic profiles of patients with lacunar or non-lacunar, acute ischemic strokes, and those recovering from stroke, and to identify microbiotic predictors of such strokes.

Background and purpose: Cognitive impairment is a common sequel of recent small subcortical infarction (RSSI) and might be negatively affected by preexisting cerebral small vessel disease (SVD). We investigated whether the course of cognitive function in patients with RSSI is influenced by the severity of white matter hyperintensities (WMH), an important imaging feature of SVD. Methods: Patients with magnetic resonance imaging (MRI)‐proven single RSSI were tested neuropsychologically concerning global cognition, processing speed, attention, and set‐shifting. Deep and periventricular WMH severity was assessed using the Fazekas scale, and total WMH lesion volume was calculated from T1‐weighted MRI images. We compared baseline function and course of cognition 15 months after the acute event in patients with absent, mild, and moderate‐to‐severe WMH. Results: The study cohort comprised 82 RSSI patients (mean age: 61 ± 10 years, 23% female). At baseline, 40% had cognitive impairment (1.5 standard deviations below standardized mean), and deficits persisted in one‐third of the sample after 15 months. After age correction, there were no significant differences in set‐shifting between WMH groups at baseline. However, although patients without WMH (deep: p < 0.001, periventricular: p = 0.067) or only mild WMH (deep: p = 0.098, periventricular: p = 0.001) improved in set‐shifting after 15 months, there was no improvement in patients with moderate‐to‐severe WMH (deep: p = 0.980, periventricular: p = 0.816). Baseline total WMH volume (p = 0.002) was the only significant predictor for attention 15 months poststroke. Conclusions: This longitudinal study demonstrates that preexisting moderate‐to‐severe WMH negatively affect the restoration of cognitive function after RSSI, suggesting limited functional reserve in patients with preexisting SVD. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate whether the detectability of brain volume change in voxel-based morphometry (VBM) with gray matter images is affected by mild white matter lesions (MWLs). Methods: Three-dimensional T1-weighted images (3D-T1WIs) of 11 healthy subjects were obtained using a 3T MR scanner. We initially created 3D-T1WIs with focal cortical atrophy simulated cortical atrophy in left amygdala (type A) and the left medial frontal lobe (type B) from control 3D-T1WIs. Next, the following three types of MWL images were created: type A + 1L and type B + 1L images, only one white matter lesion; type A + 4L and type B + 4L images, four white matter lesions at distant positions; and type A + 4L* and type B + 4L* images, four white matter lesions at clustered positions. Comparisons between the control group and the other groups were performed with VBM using segmented gray matter images. Results: The gray matter volume was significantly lower in the type A group than in the control group, and similar results were observed in the type A + 1L, type A + 4L, and type A + 4L* groups. Additionally, the gray matter volume was significantly lower in the type B group than in the control group, and similar results were observed in the type B + 1L, type B + 4L, and type B + 4L* groups, but the cluster size in type B + 4L* was smaller than that in type B. Conclusion: Our study showed that the detectability of brain volume change in VBM with gray matter images was not decreased by MWLs as lacunar infarctions. Therefore, we think that group comparisons with VBM should be analyzed by groups including and excluding subjects with MWLs, respectively. [ABSTRACT FROM AUTHOR]

Increasing evidence suggests that features of the gut microbiota correlate with ischemic stroke. However, the specific characteristics of the gut microbiota in patients suffering different types of ischemic stroke, or recovering from such strokes, have rarely been studied, and potential microbiotic predictors of different types of stroke have seldom been analyzed. We subjected fecal specimens from patients with lacunar or non-lacunar acute ischemic infarctions, and those recovering from such strokes, to bacterial 16S rRNA sequencing and compared the results to those of healthy volunteers. We identified microbial markers of different types of ischemic stroke and verified that these were of diagnostic utility. Patients with two types of ischemic stroke, and those recovering from ischemic stroke, exhibited significant shifts in microbiotic diversities compared to healthy subjects. Cluster of Orthologous Groups of Proteins (COG) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses revealed reduced metabolic and transport-related pathway activities in ischemic stroke patients. We performed fivefold cross-validation using a Random Forest model to identify two optimal bacterial species (operational taxonomic units; OTUs) serving as markers of lacunar infarction; these were Lachnospiraceae (OTU_45) and Bacteroides (OTU_4), and the areas under the receiver operating characteristic curves (AUCs under the ROCs) were 0.881 and 0.872 respectively. In terms of non-lacunar acute ischemic infarction detection, the two optimal species were Bilophila (OTU_330) and Lachnospiraceae (OTU_338); the AUCs under the ROCs were 0.985 and 0.929 respectively. In post-ischemic stroke patients, the three optimal species were Pseudomonas (OTU_35), Sphingomonadaceae (OTU_303), and Akkermansia (OTU_9); the AUCs under the ROCs were 1, 0.897, and 0.846 respectively. Notably, the gut microbial markers were of considerable value for utility when diagnosing lacunar infarction, non-lacunar acute ischemic infarction, and post-ischemic stroke. This study is the first to characterize the gut microbiotic profiles of patients with lacunar or non-lacunar, acute ischemic strokes, and those recovering from stroke, and to identify microbiotic predictors of such strokes. [ABSTRACT FROM AUTHOR]

Objectives: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common hereditary small vessel disease, with reported frequencies of 2-5/100,000 individuals. Recently, it has been reported that some patients with NOTCH3 gene mutations show atypical clinical symptoms of CADASIL. Assuming that CADASIL is underdiagnosed in some cases of lacunar infarction, this study was designed to examine the prevalence of NOTCH3 gene mutations in the patients at highest risk who were admitted for lacunar infarctions.Methods: From January 2011 to April 2018, 1,094 patients with lacunar infarctions were admitted to our hospital, of whom 31 patients without hypertension but with white matter disease (Fazekas scale 2 or 3) were selected and genetically analyzed for NOTCH3 gene mutations (Phase 1). Furthermore, 54 patients, who were 60 years or younger, were analyzed for NOTCH3 mutations (Phase 2). NOTCH3 exons 2–24, which encode the epidermal growth factor-like repeat domain of the NOTCH3 receptor, were analyzed for mutations by direct sequencing of genomic DNA.Results: Three patients presented NOTCH3 p.R75P mutations: two in the Phase 1 and one in the Phase 2 cohort. Among patients aged 60 years or younger and those without hypertension but with moderate-to-severe white matter lesions, the carrier frequency of p.R75P was 3.5% (3/85), which was significantly higher than that in the Japanese general population (4.7KJPN) (odds ratio [95% CI] = 58.2 [11.6–292.5]). All three patients with NOTCH3 mutations had family histories of stroke, and the average patient age was 51.3 years. All three patients also showed white matter lesions in the external capsule but not in the temporal pole. The CADASIL and CADASIL scale-J scores of the three patients were 6, 17, 7 (mean, 10.0) and 13, 20, 10 (mean, 14.3), respectively.Conclusion: Among patients hospitalized for lacunar infarctions, the p.R75P prevalence may be higher than previously estimated. The NOTCH3 p.R75P mutation may be underdiagnosed in patients with early-onset lacunar infarctions due to the atypical clinical and neuroimaging features of CADASIL. Early-onset, presence of family history of stroke, external capsule lesions, and absence of hypertension may help predict underlying NOTCH3 mutations despite no temporal white matter lesions.

Fang Gao,1 Qi Zhang,2 Yanan Li,1 Yanlei Tai,1 Xi Xin,3 Xiuli Wang,1 Qiujun Wang1 1Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei, People’s Republic of China; 2Department of Anesthesiology, Children’s Hospital of Hebei Province, Shijiazhuang City, Hebei, People’s Republic of China; 3Department of Anesthesiology, Tianjin Third Central Hospital, Tianjin, People’s Republic of China Purpose: This study aims to investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative delirium (POD) in elderly patients with silent lacunar infarct and preliminarily to determine the relationship among TEAS, blood–brain barrier (BBB), neuroinflammation, and POD.Patients and methods: Sixty-four-old patients with silent lacunar infarct were randomly divided into two groups: group TEAS and control group (group C). Patients in the group TEAS received TEAS (disperse-dense waves; frequency, 2/100 Hz) on acupoints Hegu and Neiguan of both sides starting from 30 minutes before induction of anesthesia until the end of surgery, and the intensity was the maximum current that could be tolerated. In group C, electrodes were placed on the same acupoints before anesthesia induction, but no current was given. At 0 minute before the treatment of TEAS, 30 minutes after skin incision, and after completion of surgery (T1–3), blood samples were extracted to detect the concentration of serum tumor necrosis factor (TNF)-α, interleukin-6 (IL-6), matrix metalloproteinase-9 (MMP-9), and S100β. We assessed patients for delirium and coma twice daily in the first 3 postoperative days using the Confusion Assessment Method for the intensive care unit and the Richmond Agitation-Sedation Scale.Results: This study preliminarily suggests that TEAS can reduce the development of POD in elderly patients with silent lacunar infarction (6.3% vs 25.0%; P=0.039). Compared with the baseline value at T1, the serum concentrations of IL-6, TNF-α, MMP-9, and S100β were significantly increased at T2–3 in both the groups (P

Background and purpose: Previous studies have revealed a relationship between chronic kidney disease (CKD) and white matter hyperintensities (WMH). However, studies on the WMH and CKD in acute stroke patients are rare, and the conclusion is consistent. Our study aimed to investigate the relationship between the severity of WMH and CKD in acute lacunar infarction patients. Methods: Consecutive acute lacunar infarction patients were recruited in this cross-sectional study. All patients were divided into two groups according to the severity of periventricular WMH (PVWMH) and deep WMH (DWMH). We dichotomized the severity of WMH (PVWMH and DWMH, separately) into mild group (Fazekas scores 0–1) and moderate-severe group (Fazekas scores 2–3). Estimated glomerular filtration rate (eGFR), proteinuria, vascular risk factors, and clinical features were compared between these two groups. Multivariable logistic regression analysis was used to investigate the association between the severity of WMH and risk factors. Results: A total of 993 acute lacunar infarction patients aged 25–95 years were enrolled. The proportions of participants presenting moderate-severe group PVWMH and DWMH were 46.6% and 38.6%, respectively. Patients with moderate-severe PVWMH had higher age (P < 0.001) and higher incidence of stroke history (P < 0.001) than those in mild group. The level of serum creatinine and the presence of CKD were significantly higher while the eGFR was significantly lower in patients with moderate-severe PVWMH than those with mild PVWMH. Patients with moderate-severe DWMH (n = 383) also had higher age (P < 0.001) and often had a history of stroke (P < 0.001). But the association between the severity of DWMH and eGFR was not found. Multivariable logistic regression analyses showed stage 2 CKD and stage 3 CKD were independently associated with moderate-severe PVWMH, but not DWMH. Conclusions: Our study demonstrates that CKD was independently associated with moderate-severe PVWMH in patients with acute lacunar infarction, but not DWMH. PVWMH and DWMH may have distinct pathophysiology. [ABSTRACT FROM AUTHOR]

Objective: The correct and rapid classification of the ischemic stroke subtype enables the determination of the proper treatment and a better prognosis. In this study, we investigated the association of ischemic stroke subtypes with early diffusion-weighted magnetic resonance imaging (MRI) lesion patterns. Materials and Methods: Three hundred forty-three consecutive patients with acute ischemic stroke were retrospectively evaluated. The ischemic stroke subtype for each patient was determined according to "Trial of Org 10172 in Acute Stroke Treatment Classification". The lesion patterns in diffusion-weighted MRI in the first 24 hours of stroke were classified as single lesions, diffuse scattered lesions limited to one vascular area, and multiple territory lesions. The relationship between the diffusion-weighted MRI lesion patterns and ischemic stroke subtypes was investigated using the chi-square test. Results: The diffusion-weighted MRI lesion patterns showed significant differences among the ischemic stroke subtypes. Multiple territory lesions were more frequent in the cardioembolic and other determined causes groups compared with the large artery atherosclerosis group. Diffuse scattered lesions limited to one vascular area were more frequent in the large artery atherosclerosis, the unknown cause and the other determined causes groups than the others (p<0.01). Single lesions with a diameter smaller than 1.5 cm favored small vessel disease. None of the diffusion-weighted MRI lesion patterns was highly specific for any stroke subtype. Conclusion: Early diffusion-weighted MRI lesion distributions vary significantly among the ischemic stroke subtypes. When evaluated with other clinical findings, these data can help in the early determination of the ischemic stroke etiology. [ABSTRACT FROM AUTHOR]

Objectives: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common hereditary small vessel disease, with reported frequencies of 2-5/100,000 individuals. Recently, it has been reported that some patients with NOTCH3 gene mutations show atypical clinical symptoms of CADASIL. Assuming that CADASIL is underdiagnosed in some cases of lacunar infarction, this study was designed to examine the prevalence of NOTCH3 gene mutations in the patients at highest risk who were admitted for lacunar infarctions. Methods: From January 2011 to April 2018, 1,094 patients with lacunar infarctions were admitted to our hospital, of whom 31 patients without hypertension but with white matter disease (Fazekas scale 2 or 3) were selected and genetically analyzed for NOTCH3 gene mutations (Phase 1). Furthermore, 54 patients, who were 60 years or younger, were analyzed for NOTCH3 mutations (Phase 2). NOTCH3 exons 2–24, which encode the epidermal growth factor-like repeat domain of the NOTCH3 receptor, were analyzed for mutations by direct sequencing of genomic DNA. Results: Three patients presented NOTCH3 p.R75P mutations: two in the Phase 1 and one in the Phase 2 cohort. Among patients aged 60 years or younger and those without hypertension but with moderate-to-severe white matter lesions, the carrier frequency of p.R75P was 3.5% (3/85), which was significantly higher than that in the Japanese general population (4.7KJPN) (odds ratio [95% CI] = 58.2 [11.6–292.5]). All three patients with NOTCH3 mutations had family histories of stroke, and the average patient age was 51.3 years. All three patients also showed white matter lesions in the external capsule but not in the temporal pole. The CADASIL and CADASIL scale-J scores of the three patients were 6, 17, 7 (mean, 10.0) and 13, 20, 10 (mean, 14.3), respectively. Conclusion: Among patients hospitalized for lacunar infarctions, the p.R75P prevalence may be higher than previously estimated. The NOTCH3 p.R75P mutation may be underdiagnosed in patients with early-onset lacunar infarctions due to the atypical clinical and neuroimaging features of CADASIL. Early-onset, presence of family history of stroke, external capsule lesions, and absence of hypertension may help predict underlying NOTCH3 mutations despite no temporal white matter lesions. [ABSTRACT FROM AUTHOR]

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Background and Purpose: Hyperhomocysteinemia (Hhcy) is a risk factor for stroke. Several studies have demonstrated that Hhcy was more closely linked to small vessel occlusive disease and white matter hyperintensities (WMH) in general and elderly population. Studies on WMH and homocysteine in elderly subjects are rare, and the results were inconsistent. Our study aimed to investigate the relationship between the serum homocysteine (HCY) and the severity of WMH in elderly lacunar stroke patients. Methods: Consecutive elderly (≥60 years old) lacunar infarction patients were recruited in this cross-sectional study. All patients were divided into two groups according to periventricular WMH (PVWMH) and deep WMH (DWMH) Fazekas scores. Patients with a Fazekas score (PVWMH or DWMH) of 0, 1, 2 were in mild-moderate group and 3 were in severe group. Vascular risk factors and clinical features were compared between these two groups. Multiple logistic regression analysis was used to determine the relationship between severity of WMH and vascular risk factors. Results: A total of 587 participants aged 60–95 years were enrolled. Patients with severe PVWMH (n = 178) had higher age (p = 0.030) and higher incidence of stroke history (p<0.001) than those in mild-moderate group. The level of serum HCY was significantly higher in patients with severe PVWMH (p ＝ 0.002). Patients with severe DWMH (n = 142) had higher age (p<0.001) and often had a history of stroke (p<0.001). The level of HCY was higher in patients with severe degree of DWMH, but had no significance (p ＝ 0.153). Multivariable logistic regression analyses showed Hhcy were independently associated with severe PVWMH after adjusted for age and vascular risk factors (p ＝ 0.014). Conclusions: Hhcy was independently associated with severe PVWMH of elderly lacunar stroke patients, but not DWMH. [ABSTRACT FROM AUTHOR]