Kai Dong

Mild encephalopathy with a reversible splenial lesion mimicking transient ischemic attack: A case report.

Background:Reversible splenial lesion syndrome (RESLES) is a newly recognized syndrome, and a reversible progress associated with transiently reduced diffusion lesion in the splenium of the corpus callosum (SCC) is the typical pathological finding. The routine clinical symptoms include mildly altered states of consciousness, delirium, and seizures. Methods:We presented a 14-year-old patient with signs suggestive of transient ischemic attack (TIA), including triple episodic weakness on the right upper limb, slurred speech, and bucking, lasting several hours in each time 2 days ago. She just had a slight cold 2 weeks ago. Results:No evidence of abnormality was found in laboratory examinations except an elevated percentage of lymphocyte. Magnetic resonance imaging revealed lesions in splenium of the corpus callosum and frontal-parietal subcortex on both cerebral hemispheres. Cerebrovascular examination was also unremarkable. The patient recovered to baseline within 25u200ahours. No treatment was given to her in hospital. In addition, the follow-up brain magnetic resonance imaging scan showed reduced lesions. TIA-like symptoms did not occur during a 30-day follow-up period. Conclusion:This young patient with RESLES type II exhibited TIA-like symptoms, which was not previously reported in literature. This case extends the recognized clinical phenotypes for this disorder.

A lower baseline glomerular filtration rate predicts high mortality and newly cerebrovascular accidents in acute ischemic stroke patients.

Abstract Chronic kidney disease (CKD) is gradually recognized as an independent risk factor for cardiovascular and cardio-/cerebrovascular disease. This study aimed to examine the association of the estimated glomerular filtration rate (eGFR) and clinical outcomes at 3 months after the onset of ischemic stroke in a hospitalized Chinese population. Totally, 972 patients with acute ischemic stroke were enrolled into this study. Modified of Diet in Renal Disease (MDRD) equations were used to calculate eGFR and define CKD. The site and degree of the stenosis were examined. Patients were followed-up for 3 months. Endpoint events included all-cause death and newly ischemic events. The multivariate logistic model was used to determine the association between renal dysfunction and patients’ outcomes. Of all patients, 130 patients (13.4%) had reduced eGFR (<60u200amL/min/1.73u200am2), and 556 patients had a normal eGFR (≥90u200amL/min/1.73u200am2). A total of 694 patients suffered from cerebral artery stenosis, in which 293 patients only had intracranial artery stenosis (ICAS), 110 only with extracranial carotid atherosclerotic stenosis (ECAS), and 301 with both ICAS and ECAS. The patients with eGFR <60u200amL/min/1.73m2 had a higher proportion of death and newly ischemic events compared with those with a relatively normal eGFR. Multivariate analysis revealed that a baseline eGFR <60u200amL/min/1.73u200am2 increased the risk of mortality by 3.089-fold and newly ischemic events by 4.067-fold. In further analysis, a reduced eGFR was associated with increased rates of mortality and newly events both in ICAS patients and ECAS patients. However, only an increased risk of newly events was found as the degree of renal function deteriorated in ICAS patients (odds ratiou200a=u200a8.169, 95% confidence intervalu200a=u200a2.445–14.127). A low baseline eGFR predicted a high mortality and newly ischemic events at 3 months in ischemic stroke patients. A low baseline eGFR was also a strong independent predictor for newly ischemic events in ICAS patients.

Clopidogrel and ischemic stroke outcomes by smoking status: Smoker's paradox?

BACKGROUND AND PURPOSEnActive smokers with myocardial infarction were shown to have enhanced benefit with clopidogrel compared with aspirin. Whether this paradox exists in ischemic stroke patients is unknown. We aimed to investigate whether smoking status has a differential impact on the efficacy of clopidogrel vs. aspirin in patients with non-cardioembolic strokes.nnnMETHODSnThis single-center study retrospectively assessed 1792 non-cardioembolic ischemic stroke patients discharged from January 2013 to October 2014, and followed for 12months. Patients were categorized as current-smokers and never-smokers. Primary outcome was a composite of secondary ischemic stroke, myocardial infarction and all-cause death. Secondary outcome was secondary ischemic stroke.nnnRESULTSn1066 patients were current-smokers and 726 were never-smokers. Compared with never-smokers, current-smokers had significantly higher rates of ischemic stroke (4.3% vs. 1.2%; adjusted OR: 3.60, 95%CI: 1.50-8.64, p=0.004). Regarding the primary outcome, among smokers, rates showed a lower trend in clopidogrel vs. aspirin groups (3.7% vs. 6.4%; adjusted OR 0.57, 95%CI: 0.31-1.07, p=0.08), but no difference among never-smokers (2.1% vs. 1.0%; adjusted OR: 1.67, 95%CI: 0.47-5.89, p=0.42). Similarly, among smokers, trending lower rates for recurrent ischemic stroke were observed in clopidogrel vs. aspirin group (3.1% vs. 5.0%; adjusted OR: 0.60, 95%CI: 0.31-1.18, p=0.14); but no difference between the two groups among never-smokers (1.7% vs. 1.0%; adjusted OR 1.36, 95%CI: 0.36-5.52, p=0.65).nnnCONCLUSIONSnSmoking is a major risk factor for recurrent stroke in our retrospective non-cardioembolic ischemic stroke cohort. Active-smokers trend toward better cardiovascular outcomes when on clopidogrel. This finding needs to be confirmed in a prospective cohort.

Severe Hyperhomocysteinemia with Two Novel Mutations of c.154T>C and c.457G>A in Cystathionine Beta-Synthase Gene

To the Editor: Hyperhomocysteinemia (HHcy) is an important risk factor for atherothrombotic disease and venous thrombosis.[1] Normally, homocysteine (Hcy) is either remethylated to methionine (Met) by a Vitamin B12‐dependent reaction or betaine as the methyl donor, or trans‐sulfurated to cysteine through a pyridoxine‐dependent reaction. Based on plasma level of total Hcy, HHcy is typically classified into three groups as follows: mild (tHcy 15–30 μmol/L), moderate (tHcy 30–100 μmol/L), and severe (tHcy >100 μmol/L).[2] Severe HHcy is rare and most commonly caused by inherited deficiency of cystathionine beta‐synthase (CBS), or less frequently, of methylenetetrahydrofolate reductase (MTHFR) genes. The presentations of this metabolic disorder include developmental delay, intellectual disability, epilepsy, ectopia lentis, myopia, hypopigmentation of the skin and hair, marfanoid habitus, and thromboembolic disorders.[3] These manifestations are often overlooked in the early stage until the occur of thrombotic events like cerebral venous sinus thrombosis (CVST).

Low Serum Albumin level as a Predictor of Hemorrhage Transformation after Intravenous Thrombolysis in Ischemic Stroke Patients

Serum albumin levels has been shown to predict outcome in ischemic stroke patients. We aimed to investigate the relationship between serum albumin levels and hemorrhagic transformation (HT) after intravenous thrombolysis (IVT) in patients with acute stroke. 428 patients receiving intravenous rt-PA therapy were included from 2013 to 2016 and were categorized into two groups: low level (<35u2009mmol/L) and normal level (35–55u2009mmol/L) group. Demographic, clinical and laboratory information, HT and functional outcomes were analyzed. Hemorrhagic transformation was comfirmed by CT scan or MRI within 7 days. The functional outcome was measured by modified Barthel Index and modified Rankin Scale (mRS) at 7 days and 90 days. Patients with lower albumin had significantly higher risk of HT (15.3% vs. 4.2%, Pu2009=u20090.002) and sICH (6.2% vs. 1.4%, Pu2009=u20090.03) than those with normal level of albumin. In univariate analysis for HT, atrial fibrillation and level of albumin were identified as significant factors (Pu2009<u20090.001, Pu2009=u20090.001 respectively). On multivariate logistic regression analysis, serum albumin level remained independent predictor of HT (ORu2009=u20094.369, 95% CIu2009=u20091.626–11.742, Pu2009=u20090.003). No significantly difference were found in the clinical outcome at 7 days and 90 days between two groups ufeff(Pu2009>u20090.05). Low level of serum albumin within 24u2009hours may be an independent predictor of post-thrombolytic HT.

Comparison of stent versus medical therapy for symptomatic patients with intracranial atherosclerotic stenosis: A meta-analysis

PURPOSEnTo compare the outcomes of intracranial stent implantation and medical therapy for treatment of severe intracranial stenosis.nnnMETHODSnArticles were identified from Medline, Cochrane, EMBASE, and Google Scholar published up to August 25, 2016. Eligible studies reported stroke occurrence, transient ischemic attack (TIA), and event-free survival rates in patients who suffered recent TIA or stroke caused by stenosis of a major intracranial artery and treated with either medical therapy or stenting. 4 studies enrolled a total 739 patients.nnnRESULTSnWhile no association between intracranial endovascular therapy and short-term stroke risk was found (pooled OR=1.349, 95% CI=0.541 to 3.367, P=0.521), significantly higher rate of stroke occurrence was observed in patients treated with stent therapy within 30days of treatment (pooled OR=3.143, 95% CI=1.755 to 5.628, P<0.001). No association was found between the type of treatment and TIA occurrence (pooled OR=0.702, 95% CI=0.277 to 1.781, P=0.457) and event-free survival rate (pooled HR=1.170, 95% CI=0.947 to 1.447, P=0.145).nnnCONCLUSIONnPatients with symptomatic intracranial atherosclerotic stenosis undergoing stent therapy may have higher risk of short-term stroke.

Relationship between Post-Thrombolysis Blood Pressure and Outcome in Acute Ischemic Stroke Patients Undergoing Thrombolysis Therapy

BACKGROUNDnThe management of blood pressure (BP) for acute ischemic stroke (AIS) patients undergoing thrombolysis is still under debate. The purpose of this study was (1) to explore the association between post-thrombolysis BP and functional outcome and (2) to examine whether post-thrombolysis BP can predict functional outcome in Chinese AIS patients undergoing thrombolysis therapy.nnnMETHODSnFrom December 2012 to November 2016, AIS patients undergoing thrombolysis were reviewed retrospectively in the Department of Neurology at Xuanwu Hospital. The BP levels were measured before and immediately after thrombolysis. Clinical outcomes, which comprised favorable outcome (modified Rankin Scale score 0-2) and unfavorable outcome (modified Rankin Scale score 3-6) at 3 months, were analyzed by logistic regression model. A receiver operating characteristic curve was used to evaluate the predictive value of post-thrombolysis BP.nnnRESULTSnPatients with unfavorable outcome at 3 months had a higher post-thrombolysis systolic BP than those with favorable outcome (Pu2009=u2009.015). Multivariate analysis showed that post-thrombolysis systolic BP below 159.5u2009mmu2009Hg was associated with favorable outcome. According to the receiver operating characteristic curve, post-thrombolysis systolic BP was a predictor of functional outcome with an area under the curve of .573 (95% confidence intervalu2009=u2009.504-.642).nnnCONCLUSIONSnOur study indicated that post-thrombolysis systolic BP is a predictor of functional outcome for Chinese AIS patients undergoing thrombolysis therapy. It is reasonable for AIS patients to keep post-thrombolysis systolic BP below 159.5u2009mmu2009Hg to obtain a favorable outcome.

The epidemiological and clinical characteristics study on epilepsy in 8 ethnic groups of China

To survey the epidemiological characteristics and clinical features on epilepsy in eight ethnic groups in Yunnan province of China.nnnMETHODESnThe investigation was based on the WHO questionnaire and ICBERG screening questionnaire. This study was performed through random cluster sampling and door-to-door survey.nnnRESULTSnA total of 76,302 individuals from eight ethnic groups were surveyed. The crude prevalence of epilepsy ranged from 1.2/1000 to 6.5/1000 in the eight ethnic groups, and the age-adjusted prevalence of epilepsy was from 2.1/1000 to 7.3/1000. The prevalence of active epilepsy varied from 1.0/1000 to 5.2/1000 in the eight ethnic groups, and the age-adjusted prevalence of active epilepsy was from 1.8/1000 to 6.7/1000. The age peak for seizures was below twenty, the patients of 61.1%-95.0% suffered from generalized seizures and 5%-21.2% had partial seizures. More than 60% of the cases in five ethnic groups, and the frequency of seizures were more than 10 events per year. More than 50% in other three ethnic groups, and the seizures had occurred less than 10 events per year. The treatment gap for active epilepsy ranged from 43.7% to 100.0% among the eight ethnic groups, while the natural remission rate varied from 5.6% to 21.0%.nnnCONCLUSIONnThere were both disparity and similarity in the epidemiological and clinical features of epilepsy in different ethnic group communities.