Brain Circulation最新文献

[This corrects the article on p. 204 in vol. 3, PMID: 30276326.].

Background: Cushing's disease is a commonly described pathology in which an excess of adrenocorticotropic hormone (ACTH) is produced by a functional pituitary adenoma. Pituitary apoplexy is an even less common pathology that occurs due to acute hemorrhage or infarct of pituitary adenomas, more commonly in nonfunctional adenomas. Very rarely do these uncommon pathologies occur simultaneously in the same patient. We present an updated systematic review on presentation and management of apoplexy in the setting of ACTH-secreting adenoma, with an unusual case illustrating presentation and management of these complex concomitant pathologies.

Methods: A systematic review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, looking at literature discussing concomitant ACTH-producing adenoma and apoplexy.

Results: Fifteen articles were included after reviewing 355 articles published from 1968-2024. Median age was 35 years. Majority of the patients (63.2%) were female. Visual acuity or visual field loss on presentation occurred in 12 (63.2%) and 7 (36.8%) patients. While 16 patients (84.2%) were treated with surgical intervention. The average follow up time was 16.7 months.

Conclusion: Pituitary apoplexy in the setting of an ACTH-secreting adenoma is an infrequently encountered scenario that can present with a confounding clinical picture. Proper recognition and diagnosis are important as the proper preoperative clinical suspicion and diagnosis alters primary goals of surgical intervention.

Stroke remains a leading cause of death and disability in China, imposing a substantial burden on public health and the economy. This China Stroke Prevention and Control Report 2024 summary report synthesizes the latest epidemiological data, risk factor management, stroke care systems, quality metrics, and screening interventions based on national surveys, the Global Burden of Disease 2021 study, and the China Stroke High-Risk Population Screening and Intervention Program (CSHR Program). In 2021, China reported 4.09 million new stroke cases, 26.34 million prevalent cases, and 2.59 million deaths, with ischemic stroke comprising the majority. Despite modest declines in age-standardized incidence (3%) and mortality (26%) from 2010 to 2021, absolute numbers continue to rise due to population aging. Key risk factors include hypertension (prevalence 25.5%, control 14.1%), diabetes (11.7%), dyslipidemia (42.1%), and lifestyle factors like smoking and physical inactivity. China's stroke care infrastructure has expanded to 1,962 centers by 2023, with improvements in prehospital response (median call-to-arrival: 39 min) and acute treatments: intravenous thrombolysis rate 9.39%, mechanical thrombectomy rate 2.56%. The CSHR Program screened over 13 million high-risk individuals, revealing gains in awareness but persistent gaps in risk factor control. Analysis of 433,284 hospitalized stroke patients showed median ages of 68, 62, and 61 years for ischemic, intracerebral hemorrhagic, and subarachnoid hemorrhagic strokes, respectively, with in-hospital mortality of 1.20% and three-month disability of 18.13%. Despite progress, challenges remain, including rural-urban disparities, increasing incidence among younger adults, and higher burden in northern regions. Future efforts should focus on primary prevention, equitable access, and integrated care to reduce the national and global stroke burden.