ObjectiveTo analyze the clinical characteristics of cerebral shock after intracerebral emorrhage (ICH) to enhance the understanding of cerebral shock after ICH. MethodsA total of 136 patients with ICH admitted to hospital from February 2010 to December 2011 were enrolled in this study.Barthel index (BI) and NIH Stroke Scale (NIHSS) were finished within 48 hours.All the patients were divided into cerebral shock group and no cerebral shock group.All of the 136 patients were matched to shock group (39 cases) and no shock group (39 cases) by the baseline NIHSS score.After 6 months,we judged the prognosis of stroke patient by mRS and compared the prognosis between the two groups. ResultsIn 136 patients,95 had cerebral shock (69.85%),and 41 didn't.The NIHSS score in the shock group was higher than that in the no shock group,but the BI score was lower in the shock group.Six months later,2 patients died in shock group,in which lost follow up was in 1,good prognosis in 11,and poor prognosis in 25.In no shock group,1 patient died,2 were lost of follow up,and the prognosis was good in 29 and poor in 7.The prognosis in the shock group was poorer than that in the no shock group. ConclusionThere are neurological deficit symptoms and poor self-care ability in ICH patients associated with brain shock.The period of brain shock impact the prognosis of the patients with cerebral hemorrhage;early functional rehabilitation for stroke patients with brain shock is expected to improve the prognosis of patients with cerebral stroke.
Objective To investigate the feasibility and clinical value of combined treatment for lung cancer with cerebral metastasis. Methods From May 1999 to May 2005, twentyone patients diagnosed lung cancer with cerebral metastasis received treatment in our hospital. The management consists of cerebral lesion resection, chemotherapy, lung cancer resection and chemotherapy or radiotherapy. Then evaluate the short-term and long-term outcome. Results No severe complications occurred in hospital. The 1-, 2-, and 3-year survival rates were 75.0%(12/16), 37.5%(6/16), and 12.5%(2/16) respectively. Life quality was promoted significantly. Conclusion Although lung cancer with cerebral metastasis is classified as stage Ⅳ,the effect of combined treatment is favorable because of the special metastatic position. But the choice of the patient is important.
Objective To analyze the risk factors of hypertension combined with cerebral hemorrhage. Methods From May 2015 to October 2016, 92 hypertension patients with cerebral hemorrhage (group A) were enrolled; simultaneously, 110 hypertension patients without cerebral hemorrhage (group B) were included. We analyzed retrospectively the clinical data of two groups and the risk factors of hypertension complicated with cerebral hemorrhage. Results The results of univariate analysis showed that the ratios of patients in group A with the following indexes, >65 years old, body mass index >30 kg/m2, >7-year smoking history, triglyceride level >1.7 mmol/L, cholesterol level >5.72 mmol/L, high density lipoprotein level >0.9 mmol/L, and bad medication compiance, were much more higher than those in group B (P<0.05). The rusults of multivariate analysis showed that smoking history, diabetes mellitus history, hypertension history, triglycerides level, cholesterol level, bad medication compliance were the risk factors of hypertension combined with cerebral hemorrhage (P<0.05). Conclusions The risk factors of hypertension combined with cerebral hemorrhage include smoking history, diabetes mellitus history, hypertension history, triglyceride level, cholesterol level, and medication compliance. We shoud pay more attention to these factors in clinical practice.
Cerebral small vessel disease is a common neurological disease, including acute and non-acute categories. With the development of neuroimaging, cerebral small vessel disease has attracted substantial attention in recent years. However, the categories and concepts of cerebral small vessel disease and the related imaging markers usually confuse people. The purpose of this study was to discuss the relationships among acute and non-acute cerebral small vessel disease and the imaging markers, so as to improve the understanding of cerebral small vessel disease, and to shed light on clinical practice and research.
In recent years, with the development of neuroimaging and the improvement of people’s awareness, the incidence of cerebral venous sinus thrombosis (CVST) has been increasing year by year. CVST with venous infarction or haemorrhage is severe, accounting for about 60% of CVST, and its clinical manifestations are serious. The current therapies including anticoagulation and intravascular treatment have not significantly improved the prognosis of severe CVST patients. The incidence of long-term poor prognosis (modified Rankin scale score≥2) is up to 56.1%. Recent research indicates that inflammation may be an important factor leading to severe CVST and is significantly associated with poor prognosis. Anti-inflammatory treatment with glucocorticoids may provide a novel method for severe CVST, but further clinical studies are needed to verify it. This paper introduces the relationship between inflammation and severe CVST in order to explore the feasibility of glucocorticoid for severe CVST.
Objective To assess the response rate, improvement in neurological function and safety of cinepazide maleate injection for patients with cerebral infarction. Methods Based on the principles and methods of Cochrane systematic reviews, we searched the Cochrane Central Register of Controlled Trials (Issue 1, 2010), PubMed (1948 to March 2010), EMbase (1966 to March 2010) and Chinese Bio-Medicine Database (1978 to March 2010). We also hand searched relevant literatures and obtained unpublished trials from pharmaceutical companies. The Cochrane Collaboration’s software RevMan5.0 was used for meta-analysis. Results Fifteen randomized controlled trials involving 1 456 patients were included. The results of meta-analyses indicated that: 1) Neurological deficits: We identified 11 trials involved 978 patients. Cinepazide maleate injection group compared with the control groups (placebo, Xuesaitong, Dansen and Nimodipine) could significantly improve the neurological deficits. The difference was statistically significant with WMD= – 4.64, 95%CI – 6.43 to – 2.85, WMD= – 2.39, 95%CI – 4.37 to – 0.42, WMD= – 3.67, 95%CI – 5.26 to – 2.07 and WMD= – 6.14, 95%CI – 8.39 to – 3.89, respectively. 2) Response rate: A total of 14 trials involved 1 349 patients were identified. Compared with control groups (placebo, Xuesaitong, Dansen and Nimodipine), cinepazide maleate injection group were more efficient, the difference was statistically significant with RR=1.33, 95%CI 1.16 to 1.54; RR=1.24, 95%CI 1.04 to 1.50; RR=1.33, 95%CI 1.23 to 1.43 and RR=1.29, 95%CI 1.12 to 1.49, respectively. 3) Adverse events: No serious adverse events were observed. But the difference of adverse events reports of headache and skin itching in cinepazide maleate injection group was statistically significant compared with the control groups. Conclusion Current evidence shows that cinepazide maleate injection can reduce neurological deficits in patients with acute cerebral infarction, improve the clinical treatment efficacy without serious adverse events. Due to limited quality of included studies, high-quality, large sample randomized controlled trials are required.
ObjectiveTo evaluate the differences of visual evoked potentials (amplitudes and latency) between cerebral palsy (CP) children and normal children. MethodsThis study involved fourteen children aged from 4 to 7 years with CP (monoplegia) between 2009 and 2013. Another 14 normal children aged from 5 to 9 years treated in the Department of Ophthalmology in West China Hospital during the same period were regarded as the control group. Both eyes of all the participants were examined by multifocal visual evoked potential (mfVEP). The mfVEP examination results were recorded, and amplitude and latency were analyzed. First, we analyzed the differences of amplitudes and latency time between monoplegia children and children in the control group. Second, gross motor function classification system (GMFCS) was used to classify the fourteen monoplegia children among whom there were five GMFCS Ⅰ patients and nine GMFCS Ⅱ patients. The differences of mfVEP were analyzed between the two GMFCS groups. ResultsThe amplitude and latency of mfVEP in children with CP showed gradual changes similar to those in the normal children. The amplitudes were decreasing and the latencies were delaying from the first eccentricity to the sixth eccentricity. The amplitudes in children with CP were lower than those in the control group in the first to the third eccentricities for both eyes (P＜0.05), and latency of left eye was delayed in the first eccentricity in children with CP (P=0.045). No difference was found between the two GMFCS groups (P>0.05) except the amplitude of the first eccentricity (P=0.043). ConclusionsThe results of mfVEP show significant differences of amplitude and latency between CP and normal children, suggesting the existence of visual pathway impairments in cerebral palsy children. The results of mfVEP can provide an objective basis of visual impairments for cerebral palsy children.
Objective To evaluate the efficacy and safety of sodium citicoline tablets in the treatment of acute cerebral hemorrhage within 72 hours from the onset. Methods A randomized , double -blind, double-dummy, active control clinical study was performed. Patients who met the inclusion criteria were randomized into two groups. The treatment group （18 cases） received sodium citicoline tablets （0.2 g tid） and placebo capsule （0. 2 g tid）, while the control group （18 cases） received sodium citicoline capsule （0.2 g tid） and placebo tablets （0. 2 g tid）. The duration of treatment was 21 days for the two groups. National Institutes of Health Stroke Scale （NIHSS） and Barthel Index （BI） were used to evaluate the recovery of neurological functions. Results NIHSS and BI scores increased significantly in both groups after treatment （P 〈0. 01 ）. There was no statistical difference of the improvement between the two groups （P 〉0. 05）. No adverse drug reaction or significant change in laboratory norms was found in either group. Conclusions Sodium citicoline tablets is effective and relatively safe in the treatment of acute cerebral hemorrhage. The efficacy and safety of sodium citicoline tablets in the treatment of acute cerebral hemorrhage is similar to that of sodium citicoline capsule.
Cerebral hemorrhage is a serious cerebrovascular disease with high morbidity and high mortality, for which timely diagnosis and treatment are crucial. Electrical impedance tomography (EIT) is a functional imaging technique which is able to detect abnormal changes of electrical property of the brain tissue at the early stage of the disease. However, irregular multi-layer structure and different conductivity properties of each layer affect image reconstruction of the brain EIT, resulting in low reconstruction quality. To solve this problem, an image reconstruction method based on an improved densely-connected fully convolutional neural network is proposed in this paper. On the basis of constructing a three-layer cerebral model that approximates the real structure of the human head, the nonlinear mapping between the boundary voltage and the conductivity change is determined by network training, which avoids the error caused by the traditional sensitivity matrix method used for solving inverse problem. The proposed method is also evaluated under the conditions with or without noise, as well as with brain model change. The numerical simulation and phantom experimental results show that conductivity distribution of cerebral hemorrhage can be accurately reconstructed with the proposed method, providing a reliable basis for the diagnosis and treatment of cerebral hemorrhage. Also, it promotes the application of EIT in the diagnosis of brain diseases.
The Chinese Guideline for Rehabilitation of Cerebral Palsy (hereinafter referred as Guideline) is the first evidence-based guideline for rehabilitation of cerebral palsy, which was compiled by Chinese experts from different fields in 2015. The Guideline suggests that the diagnosis of cerebral palsy needs to meet four essential conditions and two reference conditions. Although the cerebral palsy can be diagnosed according to the Guideline, there is still the question that whether there is a clear age definition and standardized prediction methods for early diagnosis and accurate prediction of cerebral palsy. The Guideline does not give a clear definition of age and standardized prediction methods. There is no international unified understanding or specific recommendations as well. Recently, Dr Iona Novak and other experts have pointed out that the historical viewpoint of the latent or silent period (before the age of 12-24 months) has already been outdated, because cerebral palsy or " high risk of cerebral palsy” can be accurately predicted before the corrected age of 6 months and it is possible to accurately predicte whether it is cerebral palsy or " high risk of cerebral palsy” before the corrected age of 6 months. They proposed a standardized assessment program for early diagnosis. This article introduces and discusses the relevant descriptions of the Guideline and the latest international understanding of early diagnosis and intervention of cerebral palsy.